Skip to main content
Top
Published in: Obesity Surgery 3/2021

01-03-2021 | Sleep Apnea | Original Contributions

Weight Loss as the First-Line Therapy in Patients with Severe Obesity and Obstructive Sleep Apnea Syndrome: the Role of Laparoscopic Sleeve Gastrectomy

Authors: Bilge Yılmaz Kara, Süleyman Kalcan, Songül Özyurt, Aziz Gümüş, Neslihan Özçelik, Dilek Karadoğan, Ünal Şahin

Published in: Obesity Surgery | Issue 3/2021

Login to get access

Abstract

Purpose

The objective of this study is to investigate the effects of laparoscopic sleeve gastrectomy (LSG) on the polysomnographic parameters related to OSAS.

Materials and Methods

We conducted this 3-year prospective cohort study in a tertiary care center between December 2016 and December 2019. In total, we enrolled 31 patients with severe obesity who underwent full-night polysomnography (PSG) before LSG. Later, the patients were re-evaluated by full-night PSG 12 months after the surgery.

Results

The mean age of the patients was 44.1 ± 9.6 years. The mean body mass index (BMI) decreased significantly from a mean value of 49.8 ± 8.5 kg/m2 at baseline to 33.2 ± 8.2 kg/m2 and a percent BMI (%BMI) reduction of 33.8 ± 10.4% and a percent total weight loss (%TWL) of 35.4 ± 10.8% was achieved on the same day of the postsurgical PSG (p < 0.001). There was a remarkable improvement in the AHI (baseline: 36.1 ± 27.1, 12 months after the surgery: 10.3 ± 11.8; difference: 25.8 ± 22.8 events per hour) (p < 0.001). Importantly, there was a decrease in the percentage of non-rapid eye movement (NREM) 2 (p < 0.001), whereas NREM 3 and REM stages witnessed a significant increase (p = 0.001 and p < 0.001, respectively) after the surgery.

Conclusion

The results of this study showed that weight loss after LSG yields improvement not only in AHI but also in many polysomnographic parameters such as sleep quality and desaturation indices.
Literature
1.
go back to reference Shah N, Roux F. The relationship of obesity and obstructive sleep apnea. Clin Chest Med. 2009;30(3):455–65.CrossRef Shah N, Roux F. The relationship of obesity and obstructive sleep apnea. Clin Chest Med. 2009;30(3):455–65.CrossRef
2.
go back to reference Reid M, Maras JE, Shea S, et al. Association between diet quality and sleep apnea in the Multi-Ethnic Study of Atherosclerosis. Sleep. 2019;42(1):zsy194.CrossRef Reid M, Maras JE, Shea S, et al. Association between diet quality and sleep apnea in the Multi-Ethnic Study of Atherosclerosis. Sleep. 2019;42(1):zsy194.CrossRef
3.
go back to reference Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806–14.CrossRef Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806–14.CrossRef
4.
go back to reference Busetto L, Enzi G, Inelmen EM, et al. Obstructive sleep apnea syndrome in morbid obesity: effects of intragastric balloon. Chest. 2005;128(2):618–23.CrossRef Busetto L, Enzi G, Inelmen EM, et al. Obstructive sleep apnea syndrome in morbid obesity: effects of intragastric balloon. Chest. 2005;128(2):618–23.CrossRef
5.
go back to reference Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.CrossRef Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.CrossRef
6.
go back to reference Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity executive summary. Endocr Pract. 2016;22(7):842–84.CrossRef Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity executive summary. Endocr Pract. 2016;22(7):842–84.CrossRef
7.
go back to reference Kurono T, Sakuma T, Shinozaki T, et al. A case of obstructive sleep apnea syndrome remarkably improved by gastric restriction surgery. Nihon Kyobu Shikkan Gakkai Zasshi. 1990;28(5):767–72.PubMed Kurono T, Sakuma T, Shinozaki T, et al. A case of obstructive sleep apnea syndrome remarkably improved by gastric restriction surgery. Nihon Kyobu Shikkan Gakkai Zasshi. 1990;28(5):767–72.PubMed
8.
go back to reference Ravesloot MJ, van Maanen JP, Hilgevoord AA, et al. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. Eur Arch Otorhinolaryngol. 2012;269(7):1865–71.CrossRef Ravesloot MJ, van Maanen JP, Hilgevoord AA, et al. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. Eur Arch Otorhinolaryngol. 2012;269(7):1865–71.CrossRef
9.
go back to reference O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004;14(1):23–6.CrossRef O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004;14(1):23–6.CrossRef
10.
go back to reference Xanthopoulos MS, Berkowitz RI, Tapia IE. Effects of obesity therapies on sleep disorders. Metabolism. 2018;84:109–17.CrossRef Xanthopoulos MS, Berkowitz RI, Tapia IE. Effects of obesity therapies on sleep disorders. Metabolism. 2018;84:109–17.CrossRef
11.
go back to reference Lojander J, Maasilta P, Partinen M, et al. Nasal-CPAP, surgery, and conservative management for treatment of obstructive sleep apnea syndrome. A randomized study. Chest. 1996;110(1):114–9.CrossRef Lojander J, Maasilta P, Partinen M, et al. Nasal-CPAP, surgery, and conservative management for treatment of obstructive sleep apnea syndrome. A randomized study. Chest. 1996;110(1):114–9.CrossRef
12.
go back to reference López-Padrós C, Salord N, Alves C, et al. Effectiveness of an intensive weight-loss program for severe OSAS in patients undergoing CPAP treatment: a randomized controlled trial. J Clin Sleep Med. 2020;16(4):503–14.CrossRef López-Padrós C, Salord N, Alves C, et al. Effectiveness of an intensive weight-loss program for severe OSAS in patients undergoing CPAP treatment: a randomized controlled trial. J Clin Sleep Med. 2020;16(4):503–14.CrossRef
13.
go back to reference Ainge-Allen HW, Yee BJ. A moment on the lips, a lifetime on the mask: weight-loss programs and sleep apnea. J Clin Sleep Med. 2020;16(4):471–2.CrossRef Ainge-Allen HW, Yee BJ. A moment on the lips, a lifetime on the mask: weight-loss programs and sleep apnea. J Clin Sleep Med. 2020;16(4):471–2.CrossRef
14.
go back to reference Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRef Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRef
15.
go back to reference Wolfe BM, Kvach E, Eckel RH. Treatment of obesity: weight loss and bariatric surgery. Circ Res. 2016;118(11):1844–55.CrossRef Wolfe BM, Kvach E, Eckel RH. Treatment of obesity: weight loss and bariatric surgery. Circ Res. 2016;118(11):1844–55.CrossRef
16.
go back to reference Papandreou C, Hatzis CM, Fragkiadakis GA. Effects of different weight loss percentages on moderate to severe obstructive sleep apnoea syndrome. Chron Respir Dis. 2015;12(3):276–8.CrossRef Papandreou C, Hatzis CM, Fragkiadakis GA. Effects of different weight loss percentages on moderate to severe obstructive sleep apnoea syndrome. Chron Respir Dis. 2015;12(3):276–8.CrossRef
17.
go back to reference Doff MH, Hoekema A, Wijkstra PJ, et al. Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep. 2013;36(9):1289–96.CrossRef Doff MH, Hoekema A, Wijkstra PJ, et al. Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep. 2013;36(9):1289–96.CrossRef
18.
go back to reference Veasey SC, Rosen IM. Obstructive sleep apnea in adults. N Engl J Med. 2019;380(15):1442–9.CrossRef Veasey SC, Rosen IM. Obstructive sleep apnea in adults. N Engl J Med. 2019;380(15):1442–9.CrossRef
19.
go back to reference Lynch MK, Elliott LC, Avis KT, et al. Quality of life in youth with obstructive sleep apnea syndrome (OSAS) treated with continuous positive airway pressure (CPAP) therapy. Behav Sleep Med. 2019;17(3):238–45.CrossRef Lynch MK, Elliott LC, Avis KT, et al. Quality of life in youth with obstructive sleep apnea syndrome (OSAS) treated with continuous positive airway pressure (CPAP) therapy. Behav Sleep Med. 2019;17(3):238–45.CrossRef
20.
go back to reference Taşbakan MS, Kaçmaz Başoğlu Ö, Yıldırım Şimşir I, et al. Obstructive sleep apnea characteristics in patients with well-controlled acromegaly and their compliance with positive airway pressure therapy. Turk J Med Sci. 2017;47(5):1348–53.CrossRef Taşbakan MS, Kaçmaz Başoğlu Ö, Yıldırım Şimşir I, et al. Obstructive sleep apnea characteristics in patients with well-controlled acromegaly and their compliance with positive airway pressure therapy. Turk J Med Sci. 2017;47(5):1348–53.CrossRef
21.
go back to reference Schoch OD, Baty F, Niedermann J, et al. Baseline predictors of adherence to positive airway pressure therapy for sleep apnea: a 10-year single-center observational cohort study. Respiration. 2014;87(2):121–8.CrossRef Schoch OD, Baty F, Niedermann J, et al. Baseline predictors of adherence to positive airway pressure therapy for sleep apnea: a 10-year single-center observational cohort study. Respiration. 2014;87(2):121–8.CrossRef
22.
go back to reference Zozula R, Rosen R. Compliance with continuous positive airway pressure therapy: assessing and improving treatment outcomes. Curr Opin Pulm Med. 2001;7(6):391–8.CrossRef Zozula R, Rosen R. Compliance with continuous positive airway pressure therapy: assessing and improving treatment outcomes. Curr Opin Pulm Med. 2001;7(6):391–8.CrossRef
23.
go back to reference Zhu D, Wu M, Cao Y, et al. Heated humidification did not improve compliance of positive airway pressure and subjective daytime sleepiness in obstructive sleep apnea syndrome: a meta-analysis. PLoS One. 2018;13(12):e0207994.CrossRef Zhu D, Wu M, Cao Y, et al. Heated humidification did not improve compliance of positive airway pressure and subjective daytime sleepiness in obstructive sleep apnea syndrome: a meta-analysis. PLoS One. 2018;13(12):e0207994.CrossRef
24.
go back to reference Sanches E, Timmermans M, Topal B, et al. Cardiac remodeling in obesity and after bariatric and metabolic surgery; is there a role for gastro-intestinal hormones? Expert Rev Cardiovasc Ther. 2019;17(11):771–90.CrossRef Sanches E, Timmermans M, Topal B, et al. Cardiac remodeling in obesity and after bariatric and metabolic surgery; is there a role for gastro-intestinal hormones? Expert Rev Cardiovasc Ther. 2019;17(11):771–90.CrossRef
25.
go back to reference Pujol Rafols J, Al Abbas AI, Devriendt S, et al. Roux-en-Y gastric bypass, sleeve gastrectomy, or one anastomosis gastric bypass as rescue therapy after failed adjustable gastric banding: a multicenter comparative study. Surg Obes Relat Dis. 2018;14(11):1659–66.CrossRef Pujol Rafols J, Al Abbas AI, Devriendt S, et al. Roux-en-Y gastric bypass, sleeve gastrectomy, or one anastomosis gastric bypass as rescue therapy after failed adjustable gastric banding: a multicenter comparative study. Surg Obes Relat Dis. 2018;14(11):1659–66.CrossRef
26.
go back to reference Bianco P, Rizzuto A, Velotti N, et al. Results following laparoscopic sleeve gastrectomy in elderly obese patients: a single center experience with follow-up at three years. Minerva Chir. 2020;75(2):77–82.CrossRef Bianco P, Rizzuto A, Velotti N, et al. Results following laparoscopic sleeve gastrectomy in elderly obese patients: a single center experience with follow-up at three years. Minerva Chir. 2020;75(2):77–82.CrossRef
27.
go back to reference Del Genio G, Limongelli P, Del Genio F, et al. Sleeve gastrectomy improves obstructive sleep apnea syndrome (OSAS): 5 year longitudinal study. Surg Obes Relat Dis. 2016;12(1):70–4.CrossRef Del Genio G, Limongelli P, Del Genio F, et al. Sleeve gastrectomy improves obstructive sleep apnea syndrome (OSAS): 5 year longitudinal study. Surg Obes Relat Dis. 2016;12(1):70–4.CrossRef
28.
go back to reference Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2016;151(11):1046–55.CrossRef Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2016;151(11):1046–55.CrossRef
29.
go back to reference Manning S, Pucci A, Carter NC, et al. Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc. 2015;29(6):1484–91.CrossRef Manning S, Pucci A, Carter NC, et al. Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc. 2015;29(6):1484–91.CrossRef
30.
go back to reference Gadiot RP, Biter LU, van Mil S, et al. Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obes Surg. 2017;27(1):59–63.CrossRef Gadiot RP, Biter LU, van Mil S, et al. Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obes Surg. 2017;27(1):59–63.CrossRef
31.
go back to reference Neagoe R, Muresan M, Timofte D, et al. Long-term outcomes of laparoscopic sleeve gastrectomy - a single-center prospective observational study. Wideochir Inne Tech Maloinwazyjne. 2019;14(2):242–8.PubMedPubMedCentral Neagoe R, Muresan M, Timofte D, et al. Long-term outcomes of laparoscopic sleeve gastrectomy - a single-center prospective observational study. Wideochir Inne Tech Maloinwazyjne. 2019;14(2):242–8.PubMedPubMedCentral
32.
go back to reference Duarte RL, Magalhães-da-Silveira FJ. Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography. J Bras Pneumol. 2015;41(5):440–8.CrossRef Duarte RL, Magalhães-da-Silveira FJ. Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography. J Bras Pneumol. 2015;41(5):440–8.CrossRef
33.
go back to reference Modena DAO, Cazzo E, Cândido EC, et al. Obstructive sleep apnea syndrome among obese individuals: a cross-sectional study. Rev Assoc Med Bras (1992). 2017;63(10):862–8.CrossRef Modena DAO, Cazzo E, Cândido EC, et al. Obstructive sleep apnea syndrome among obese individuals: a cross-sectional study. Rev Assoc Med Bras (1992). 2017;63(10):862–8.CrossRef
34.
go back to reference Temirbekov D, Güneş S, Yazıcı ZM, et al. The ignored parameter in the diagnosis of obstructive sleep apnea syndrome: the oxygen desaturation index. Turk Arch Otorhinolaryngol. 2018;56(1):1–6.CrossRef Temirbekov D, Güneş S, Yazıcı ZM, et al. The ignored parameter in the diagnosis of obstructive sleep apnea syndrome: the oxygen desaturation index. Turk Arch Otorhinolaryngol. 2018;56(1):1–6.CrossRef
35.
go back to reference Khan MT, Franco RA. Complex sleep apnea syndrome. Sleep Disord. 2014;2014:798487.CrossRef Khan MT, Franco RA. Complex sleep apnea syndrome. Sleep Disord. 2014;2014:798487.CrossRef
36.
go back to reference Borsini E, Blanco M, Schonfeld S, et al. Performance of Epworth Sleepiness Scale and tiredness symptom used with simplified diagnostic tests for the identification of sleep apnea. Sleep Sci. 2019;12(4):287–94.PubMedPubMedCentral Borsini E, Blanco M, Schonfeld S, et al. Performance of Epworth Sleepiness Scale and tiredness symptom used with simplified diagnostic tests for the identification of sleep apnea. Sleep Sci. 2019;12(4):287–94.PubMedPubMedCentral
37.
go back to reference Velázquez-Fernández D, Sánchez H, Monraz F, et al. Development of an interactive outcome estimation tool for laparoscopic Roux-en-Y gastric bypass in Mexico based on a cohort of 1002 patients. Obes Surg. 2019;29(9):2878–85.CrossRef Velázquez-Fernández D, Sánchez H, Monraz F, et al. Development of an interactive outcome estimation tool for laparoscopic Roux-en-Y gastric bypass in Mexico based on a cohort of 1002 patients. Obes Surg. 2019;29(9):2878–85.CrossRef
38.
go back to reference Morselli LL, Temple KA, Leproult R, et al. Determinants of slow-wave activity in overweight and obese adults: roles of sex, obstructive sleep apnea and testosterone levels. Front Endocrinol. 2018;9:377.CrossRef Morselli LL, Temple KA, Leproult R, et al. Determinants of slow-wave activity in overweight and obese adults: roles of sex, obstructive sleep apnea and testosterone levels. Front Endocrinol. 2018;9:377.CrossRef
39.
go back to reference Van Cauter E, Spiegel K, Tasali E, et al. Metabolic consequences of sleep and sleep loss. Sleep Med. 2008;9(Suppl 1(0 1)):S23–8.CrossRef Van Cauter E, Spiegel K, Tasali E, et al. Metabolic consequences of sleep and sleep loss. Sleep Med. 2008;9(Suppl 1(0 1)):S23–8.CrossRef
40.
go back to reference Ju YS, Zangrilli MA, Finn MB, et al. Obstructive sleep apnea treatment, slow wave activity, and amyloid-β. Ann Neurol. 2019;85(2):291–5.CrossRef Ju YS, Zangrilli MA, Finn MB, et al. Obstructive sleep apnea treatment, slow wave activity, and amyloid-β. Ann Neurol. 2019;85(2):291–5.CrossRef
Metadata
Title
Weight Loss as the First-Line Therapy in Patients with Severe Obesity and Obstructive Sleep Apnea Syndrome: the Role of Laparoscopic Sleeve Gastrectomy
Authors
Bilge Yılmaz Kara
Süleyman Kalcan
Songül Özyurt
Aziz Gümüş
Neslihan Özçelik
Dilek Karadoğan
Ünal Şahin
Publication date
01-03-2021
Publisher
Springer US
Published in
Obesity Surgery / Issue 3/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-020-05080-4

Other articles of this Issue 3/2021

Obesity Surgery 3/2021 Go to the issue