Multimodal anesthesia management of a morbidly obese spinal muscular atrophy patient with obstructive sleep apnea

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

Download Full-text

Neurocognitive deficits in morbidly obese children with obstructive sleep apnea

The Journal of Pediatrics ◽

10.1016/s0022-3476(95)70164-8 ◽

1995 ◽

Vol 127 (5) ◽

pp. 741-744 ◽

Cited By ~ 149

Author(s):

Susan K. Rhodes ◽

Kim C. Shimoda ◽

L.Randolph Waid ◽

Patrick Mahlen O'Neil ◽

Mary Joan Oexmann ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Morbidly Obese ◽

Neurocognitive Deficits ◽

Obese Children ◽

Obstructive Sleep

Download Full-text

Shar Pei Larynx: Supraglottic and Postcricoid Mucosal Redundancy and Its Association With Medical Comorbidities

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418810893 ◽

2018 ◽

Vol 128 (2) ◽

pp. 121-127 ◽

Cited By ~ 2

Author(s):

Yin Yiu ◽

Kathleen M. Tibbetts ◽

C. Blake Simpson ◽

Laura A. Matrka

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Laryngopharyngeal Reflux ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Future Research ◽

Morbidly Obese ◽

Reflux Symptom Index ◽

Symptom Index ◽

Obstructive Sleep

Objectives: The aim of this study is to describe a clinical entity the authors term “Shar Pei larynx,” characterized by redundant supraglottic and postcricoid mucosa that the authors hypothesize coexists in patients with obstructive sleep apnea, laryngopharyngeal reflux, and obesity. By exploring this hypothesis, the authors hope to set the foundation for future research with the goal of identifying whether Shar Pei larynx is a marker for untreated sleep apnea or other diseases. Study Design: Retrospective chart review. Setting: Two tertiary care academic institutions. Methods: Data were collected from a 5-year period by querying for patients described to have “Shar Pei larynx” or “posterior supraglottic and/or postcricoid mucosal redundancy” on laryngoscopic findings. Relevant demographic and clinical characteristics were analyzed, with a focus on associations with obesity, sleep apnea, and laryngopharyngeal reflux. Results: Thirty-two patients were identified with physical findings consistent with Shar Pei larynx. Twenty-six patients (81.3%) were obese; 16 (50%) were morbidly obese. Twenty-two patients (68.8%) either had an existing diagnosis of obstructive sleep apnea or were diagnosed on polysomnography performed after initial evaluation. Sixteen patients (50%) had type 2 diabetes mellitus, and 87.5% of these patients were obese. Twenty-eight patients (87.5%) noted histories of reflux, with a median reflux symptom index of 27 of 45. Five patients underwent procedures to reduce mucosal redundancy related to Shar Pei larynx. Conclusions: This pilot study confirms that the majority of patients diagnosed with Shar Pei larynx also had diagnoses of obesity, obstructive sleep apnea, and reflux disease. The demonstrated association is strong enough to warrant further study.

Download Full-text

The association of NOV/CCN3 with obstructive sleep apnea (OSA): preliminary evidence of a novel biomarker in OSA

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2017-0029 ◽

2017 ◽

Vol 31 (2) ◽

Cited By ~ 3

Author(s):

Jeremy A. Weingarten ◽

Lars Bellner ◽

Stephen J. Peterson ◽

Moe Zaw ◽

Puja Chadha ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Matrix Protein ◽

Strong Association ◽

Preliminary Evidence ◽

Extracellular Matrix Protein ◽

Morbidly Obese ◽

Potential Marker ◽

Obstructive Sleep ◽

Obese Subjects

AbstractObstructive sleep apnea (OSA) has a strong association with cardiovascular and metabolic abnormalities, although the mechanism driving this association is not well established. NOV/CCN3, a multifunctional extracellular matrix protein, may play a mechanistic and/or prognostic role in these associations. We hypothesized that patients with OSA, which primarily affects obese individuals, will have increased levels of NOV, and that NOV can serve as a biomarker in patients to predict OSA as well as metabolic and cardiac risk. Ten morbidly obese and 10 healthy lean subjects underwent overnight polysomnography (PSG) and clinical evaluation. Blood samples were analyzed for NOV levels, adiponectin and IL-6. OSA was found in nine obese subjects and three lean subjects. NOV levels were significantly higher in the OSA vs. no OSA group (2.1 ± 0.9 vs. 1.3 ± 0.8, p < 0.03). NOV levels were significantly higher in the obese vs. lean group (2.2 ± 0.3 vs. 1.4 ± 0.2-fold change, p < 0.03). Among lean subjects, NOV levels were significantly higher in the OSA vs. no OSA group (2.1 ± 0.9 vs. 1.0 ± 0.4, p < 0.05). NOV and AHI were positively correlated (ρ = 0.49, p = 0.033). IL-6 and adiponectin differences in obese vs. lean and OSA vs. no OSA were consistent with an inflammatory phenotype in obese subjects and OSA subjects. NOV is a novel biomarker of the presence and severity of OSA and a potential marker of future cardiovascular and metabolic disease in OSA patients.

Download Full-text