TITLE:
Obesity and obstructive sleep apnea, bariatric surgery and follow-up post treatment
AUTHORS:
Won Hee Seo, Christian Guilleminault
KEYWORDS:
Obstructive Sleep Apnea; Obesity; Bariatric Surgery; Blood Pressure; Flow Limitation
JOURNAL NAME:
Health,
Vol.5 No.8C,
August
13,
2013
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.