Health> Vol.5 No.8C, August 2013

Obesity and obstructive sleep apnea, bariatric surgery and follow-up post treatment

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ABSTRACT

Bariatric surgery is a valid treatment alternative for obese patients with obstructive sleep apnea (OSA), but subjects who are overweight or obese represent a poor model to investigate the role of OSA treatment on cardiovascular variables, calling into question the attribution of cardiovascular and metabolic problems associated with OSA with excess weight. Seventeen patients with significant obesity who demonstrated OSA with a high apnea-hypopnea index (AHI) were treated with bariatric surgery alone after refusal of nasal continuous positive airway pressure (CPAP) treatment. At approximately 3 years post-surgery, subjects demonstrated a significant drop in blood pressure measured at rest, improvement in sleepiness and fatigue visual analogue scales, but continued to complain of daytime sleepiness. Polysomnography in these subjects demonstrated relative improvement in AHI, but patients continued to have a significant number of respiratory events and episodes of flow limitation.  Subsequent treatment with a dental device led to further improvement in nocturnal respiration, but did not reduce AHI to a normal range on repeat polysomnography. In this study we demonstrate that bariatric surgery alone and in conjunction with a dental device may significantly reduce AHI but does not eliminate daytime fatigue and sleepiness. Systematic long term follow-up examining the persistence of sleep related abnormalities should be performed particularly if daytime fatigue or sleepiness is still present in patients with OSA after treatment with bariatric surgery alone.

Cite this paper

Seo, W. and Guilleminault, C. (2013) Obesity and obstructive sleep apnea, bariatric surgery and follow-up post treatment. Health, 5, 40-46. doi: 10.4236/health.2013.58A3006.

References

[1] Gerardy, W., Herberg, D. and Kuhn, H. (1960) Vergleichende untersuchungen der lungenfunktion und des elektroen-cephalogramms bie zwei patienten mit pickwickiansyndrom. Zeitschrift Fur Klinische Psychologie Psychiatrie Und Psychotherapie, 156, 362-380.
[2] Guilleminault, C., Eldridge, F. and Dement, W. (1972) Insomnia, narcolepsy, and sleep apneas. Bulletin de physio-pathologie respiratoire, 8, 1127-1138.
[3] Guilleminault, C., Tilkian, A. and Dement, W.C. (1976) The sleep apnea syndromes. Annual Review of Medicine, 27, 465-484. doi:10.1146/annurev.me.27.020176.002341
[4] Douglass, A.B., Bornstein, R.F., Nino-Murcia, G. and Keenan, S. (1994) The sleep disorders questionnaire: I. Creation and multivariate structure of SDQ. Sleep: Journal of Sleep Research & Sleep Medicine, 17, 160-167.
[5] Iber, C., Ancoli-Israel, S., Chesson, A. and Quan, S.F. (2007) The AASM manual for the scoring of sleep and associated events: Rules, terminology and technical specifications. American Academy of Sleep Medicine, Westchester.
[6] Hosselet, J.J., Norman, R.G., Ayappa, I. and Rapoport, D. (1998) Detection of flow limitation with a nasal cannula/pressure transducer system. American Journal of Respiratory and Critical care Medicine, 157, 1461-1467. doi:10.1164/ajrccm.157.5.9708008
[7] Schwab, R.J., Pasirstein, M., Pierson, R., Mackley, A., Hachadoorian, R., Arens, R., Maislin, G. and Pack, A.I. (2003) Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. American Journal of Respiratory and Critical Care Medicine, 168, 522-530. doi:10.1164/rccm.200208-866OC
[8] Jamieson, A., Guilleminault, C., Partinen, M. and Quera-Salva, M.A. (1986) Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep, 9, 469-477.
[9] Stoohs, R.A., Facchini, F. and Guilleminault, C. (1996) Insulin resistance and sleep-disordered breathing in healthy humans. American Journal of Respiratory and Critical Care Medicine, 154, 170-174. doi:10.1164/ajrccm.154.1.8680675
[10] Wolf, P.A., Beiser, A., Elias, M.F., Au, R., Vasan, R.S. and Seshadri, S. (2007) Relation of obesity to cognitive function: importance of central obesity and synergistic influence of concomitant hypertension. The Framingham Heart Study. Current Alzheimer Research, 4, 111-116. doi:10.2174/156720507780362263
[11] Gazdzinski, S., Millin, R., Kaiser, L.G., Durazzo, T.C., Mueller, S.G., Weiner, M.W. and Meyerhoff, D.J. (2010) BMI and neuronal integrity in healthy, cognitively normal elderly: A proton magnetic resonance spectroscopy study. Obesity, 18, 743-748. doi:10.1038/oby.2009.325
[12] Cournot, M., Marquie, J., Ansiau, D., Martinaud, C., Fonds, H., Ferrieres, J. and Ruidavets, J.B. (2006) Relation between body mass index and cognitive function in healthy middle-aged men and women. Neurology, 67, 1208-1214. doi:10.1212/01.wnl.0000238082.13860.50
[13] Guilleminault, C. and Stoohs, R. (1995) Arousal, increased respiratory efforts, blood pressure and obstructive sleep apnoea. Journal of Sleep Research, 4, 117-124. doi:10.1111/j.1365-2869.1995.tb00200.x
[14] Tantrakul, V., Park C.S. and Guilleminault, C. (2012) Sleep-disordered breathing in premenopausal women: Differences between younger (less than 30years old) and older women. Sleep Medicine, 13, 656-662. doi:10.1016/j.sleep.2012.02.008
[15] Tantrakul, V. and Guilleminault, C. (2009) Chronic sleep complaints in premenopausal women and their association with sleep-disordered breathing. Lung, 187, 82-92. doi:10.1007/s00408-009-9137-7
[16] Greenberg, I., Perna, F., Kaplan, M. and Sullivan, M.A. (2005) Behavioral and psychological factors in the assessment and treatment of obesity surgery patients. Obesity Research, 13, 244-249. doi:10.1038/oby.2005.33
[17] Guilleminault, C. and Rosekind, M. (1981) The arousal threshold: sleep deprivation, sleep fragmentation, and obstructive sleep apnea syndrome. Bulletin Européen de Physiopathologie Respiratoire, 17, 341-349.
[18] Terzano, M.G., Parrino, L., Sherieri, A., Chervin, R., Chokroverty, S., Guilleminault, C., Hirshkowitz, M., Mahowald, M., Moldofsky, H. and Rosa, A. (2001) Atlas, rules, and recording techniques for the scoring of cyclic alternating pattern (CAP) in human sleep. Sleep medicine, 2, 537-553. doi:10.1016/S1389-9457(01)00149-6
[19] Guilleminault, C., Poyares, D., Rosa, Ad., Kirisoglu, C., Almeida, T.L. and Maria C. (2006) Chronic fatigue, unrefreshing sleep and nocturnal polysomnography. Sleep Medicine, 7, 513-520. doi:10.1016/j.sleep.2006.03.016
[20] Aittokallio T., Saaresranta T., Polo-Kantola P., Nevalainen, O. and Polo, O. (2001) Analysis of inspiratory flow shapes in patients with partial upper-airway obstruction during sleep. Chest, 119, 37-44. doi:10.1378/chest.119.1.37
[21] Palombini, L., Tufik, S., Rapoport, D., Ayappa, I., Guilleminault, C., De Godoy, L., Casto, L. and Bittencourt, L. (2013) Inspiratory flow limitation in a normal population of adults in Sao Paolo, Brazil. Proceeding of Sleep.

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