Prevalence of Sleep Apnea in Morbidly Obese Patients who Presented for Weight Loss Surgery Evaluation: More Evidence for Routine Screening for Obstructive Sleep Apnea before Weight Loss Surgery

2008 ◽  
Vol 74 (9) ◽  
pp. 834-838 ◽  
Author(s):  
Peter P. Lopez ◽  
Bianca Stefan ◽  
Carl I. Schulman ◽  
Patricia M. Byers
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Weight Loss Surgery ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
The Mean

The incidence of obstructive sleep apnea has been underestimated in morbidly obese patients who present for evaluation for weight loss surgery. This retrospective study shows that the incidence of obstructive sleep apnea in this patient population is greater than 70 per cent and increases in incidence as the body mass index increases. Obstructive sleep apnea (OSA) is a common comorbidity in obese patients who present for evaluation for gastric bypass surgery. The incidence of sleep apnea in obese patients has been reported to be as high as 40 per cent. A retrospective review of our prospectively collected database was performed. All patients being evaluated for weight loss surgery for obesity were screened preoperatively for OSA using a sleep study. The overall incidence of sleep apnea in our patients was 78 per cent (227 of 290). All 227 were diagnosed by formal sleep study. There were 63 (22%) males and 227 (78%) females. The mean age was 43 years (range, 17–75 years). The mean body mass index (BMI) was 52 kg/m2 (range, 31–94 kg/m2). The prevalence of OSA in the severely obese group (BMI 35–39.9 kg/m2) was 71 per cent. For the morbidly obese group (BMI 40–40.9 kg/m2), the prevalence was 74 per cent and for the superobese group (BMI 50–59.9 kg/m2) 77 per cent. Those with a BMI 60 kg/m2 or greater, the prevalence of OSA rose to 95 per cent. The incidence of sleep apnea in patients presenting for weight loss surgery was greater than 70 per cent in our study. Patients presenting for weight loss surgery should undergo a formal sleep study to diagnose OSA before bariatric surgery.

The Morbidly Obese Surgical Patient

2020 ◽  
Author(s):  
Michael A. Schweitzer ◽  
Gregory Grimberg
Keyword(s):  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Venous Thromboembolism ◽  
Sleep Apnea ◽  
Children And Adolescents ◽  
Respiratory Insufficiency ◽  
Gastric Surgery ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep

Over the past few decades, the incidence of obesity has been steadily rising in the United States. The Centers for Disease Control and Prevention estimates greater than 40% of the US adult population is obese. Rising obesity rates are also increasing among children and adolescents as well, with nearly one in five children and adolescents considered obese. As a result, surgeons today face the challenge of caring for an increasing number of morbidly obese patients, and this trend is expected to worsen over time. This review covers preoperative evaluation, obesity-related comorbidities, respiratory insufficiency, anesthesia in patients with respiratory insufficiency, intraoperative management, postoperative management, complications of gastric surgery for obesity, diabetes mellitus, wound care, and other obesity-related diseases. Figures show impaired pulmonary function in the morbidly obese improved significantly after weight loss induced by bariatric surgery, significant improvement in mean pulmonary arterial pressure in 18 patients, 3 to 9 months after gastric surgery-induced weight loss of 42% ± 19% of excess weight, and a chronic venous stasis ulcer present for several years in a morbidly obese patient. The tables list evaluation and treatment of obstructive sleep apnea, and indications for extended postoperative chemoprophylaxis for venous thromboembolism in morbidly obese patients. This review contains 3 highly rendered figures, 2 tables, and 46 references Keywords: morbid obesity, obesity, metabolic surgery, venous thromboembolism chemoprophylaxis, Obstructive Sleep Apnea

scholarly journals The Effect of Laparoscopic Sleeve Gastrectomy on Obstructive Sleep Apnea Syndrome

2018 ◽  
Author(s):  
Tuğrul Çakır ◽  
Hülya Eyigör ◽  
Arif Aslaner ◽  
Nurullah Bülbüller ◽  
Mehmet Tahir Oruç ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleeve Gastrectomy ◽  
Sleep Apnea ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Morbidly Obese ◽  
Safe Procedure ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Severely Obese ◽  
The Mean

Background: The repeated episode of obstructive hypopnea and apnea during sleep is defined as obstructive sleep apnea (OSA) and it is a common condition in obese patients. Studies performing bariatric surgery have demonstrated a significant improvement in OSA by weight reduction. In this prospective study we aimed to explore the efficacy and safety of Laparoscopic Sleeve Gastrectomy (LSG) on OSAS among severely obese patients. Material and Methods: A total of 32 morbidly obese patients who underwent LSG for morbid obesity were included in this study. Body weight, height, body mass index (BMI) and standard overnight polysomnography (PSG) were measured at before and after LSG at the 6th month.  Results: 32 patients (27 female, 5 male) who have postoperative PSG's were included in this study. The mean age was 43.22±9.87 years old. The mean preoperative and postoperative BMIs were 50.36±8.14kg/m² and 37.27±7.93kg/m², respectively. The mean Epworth sleepiness scale determined as 5.84±4.65 preoperatively and 2.19±3.55 postoperatively. The preoperative and postoperative sleep efficiency test of the patients was determined as 83.34±9.68 and 88.94±6.90 respectively. AHI average at the preoperative PSG was 31.47±26.34, while 9.35±10:34 at postoperative 6 months and found as statistically significant. Conclusion: Our data showed that LSG is an efficient and safe procedure on severely obese patients and showed a predictive remission of clinical and sleep parameters of patients with OSA by analyzing PSG data during the first 6 months.

The Morbidly Obese Surgical Patient

2020 ◽  
Author(s):  
Michael A. Schweitzer ◽  
Gregory Grimberg
Keyword(s):  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Venous Thromboembolism ◽  
Sleep Apnea ◽  
Children And Adolescents ◽  
Respiratory Insufficiency ◽  
Gastric Surgery ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep

Over the past few decades, the incidence of obesity has been steadily rising in the United States. The Centers for Disease Control and Prevention estimates greater than 40% of the US adult population is obese. Rising obesity rates are also increasing among children and adolescents as well, with nearly one in five children and adolescents considered obese. As a result, surgeons today face the challenge of caring for an increasing number of morbidly obese patients, and this trend is expected to worsen over time. This review covers preoperative evaluation, obesity-related comorbidities, respiratory insufficiency, anesthesia in patients with respiratory insufficiency, intraoperative management, postoperative management, complications of gastric surgery for obesity, diabetes mellitus, wound care, and other obesity-related diseases. Figures show impaired pulmonary function in the morbidly obese improved significantly after weight loss induced by bariatric surgery, significant improvement in mean pulmonary arterial pressure in 18 patients, 3 to 9 months after gastric surgery-induced weight loss of 42% ± 19% of excess weight, and a chronic venous stasis ulcer present for several years in a morbidly obese patient. The tables list evaluation and treatment of obstructive sleep apnea, and indications for extended postoperative chemoprophylaxis for venous thromboembolism in morbidly obese patients. This review contains 3 highly rendered figures, 2 tables, and 46 references Keywords: morbid obesity, obesity, metabolic surgery, venous thromboembolism chemoprophylaxis, Obstructive Sleep Apnea

Weight Loss Ameliorates Markers of Systemic Inflammation and Endothelial Dysfunction in Obstructive Sleep Apnea Obese Patients

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Shehab M Abd El-Kader
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Weight Reduction ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Adhesive Molecules

Background: Obstructive sleep apnea (OSA) is the most common sleep disorder in clinical practice. Its growing worldwide prevalence may be due to the rising incidence of obesity in the public. OSA has been increasingly recognized as a major public health issue, as it has a significant influence on the incidence and prognosis of cardiovascular diseases. Although, these abnormalities could be modulated with weight reduction, there is limitation in clinical studies have addressed the beneficial effects of weight reduction in modulating biomarkers of endothelial dysfunction and cytokines for obesity associated with OSA. Objective: This study was designed to detect the effects of weight loss on the inflammatory cytokines and adhesive molecules in obese patients with obstructive sleep apnea. Methods: Seventy obese patients with moderate to severe OSA (the apnea-hypopnea index (AHI)>15 events/hour), their age ranged from 36- 50 years and their body mass index ranged from 26-31kg/m2 were equally assigned into two groups: the weight reduction group received aerobic exercises, diet regimen, where the control group received no intervention for 12 weeks. Results: The mean values of body mass index (BMI), apnea-hypopnea index (AHI), tumor necrosis factor –alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), inter-cellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1) and E-selectin were significantly decreased in the training group, however the results of the control group were not significant. In addition, there were significant differences between both groups at the end of the study. Conclusion: Weight loss ameliorates inflammatory cytokines and adhesive molecules among obese patients with obstructive sleep apnea.

Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

2020 ◽  
Vol 103 (8) ◽  
pp. 725-728
Keyword(s):  
Bariatric Surgery ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lifestyle Modification ◽  
Apnea Hypopnea Index ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Objective Evidence

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)

scholarly journals The efficiency of obesity treatment in patients with insomnia and obstructive sleep apnea syndrome

2015 ◽  
Vol 13 (2) ◽  
pp. 25-32
Author(s):  
Natal'ya V. Strueva ◽  
Galina A. Mel'nichenko ◽  
Mikhail G. Poluektov ◽  
Larisa V. Savel'eva
Keyword(s):  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Body Weight ◽  
Sleep Apnea ◽  
Sleep Disorders ◽  
Sleep Apnea Syndrome ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Apnea Syndrome ◽  
Clinically Significant

The aim of this study was to investigate the relationship between the dynamics of body weight and sleep disorders in the treatment of obesity.Materials and methods. The study included 200 obese patients: 83 men and 117 women.Results. Complaints about problems sleeping (snoring, hypersomnia, insomnia, etc.) were present in 78% of obese patients. 89 patients were under the observation of an endocrinologist for 7 ± 1 months, they were divided into three matched by age, sex and BMI groups: patients with obstructive sleep apnea syndrome (OSAS) (n = 42), the second – with the syndrome of insomnia (n = 19), the third (control group) – patients without sleep disorders (n = 24). After treatment of obesity the weight loss in patients with insomnia syndrome was -2.5 [-4; 0]kg, in patients with OSAS -7 [-18; -2] kg, in patients without sleep disorders -6.5 [-12; -2.25] kg. Clinically significant weight reduction was reached in 25 (59.5%) patients with OSAS; 3 (16%) – with insomnia syndrome; 15 (62.5%) – without sleep disorders.Conclusion. Thus, the insomnia syndrome essentially influences the obesity treatment results – most of patients with this sleep disorder (81.2%) do not achieve clinically significant weight loss. The presence and severity of breathing disorders during sleep do not prevent weight loss. However, with the regular use of CPAP-therapy in patients with OSAS has a tendency of greater reduction of body weight. 

scholarly journals Accuracy of Postoperative End-tidal Pco2Measurements with Mainstream and Sidestream Capnography in Non-obese Patients and in Obese Patients with and without Obstructive Sleep Apnea

2009 ◽  
Vol 111 (3) ◽  
pp. 609-615 ◽  
Author(s):  
Yusuke Kasuya ◽  
Ozan Akça ◽  
Daniel I. Sessler ◽  
Makoto Ozaki ◽  
Ryu Komatsu
Keyword(s):  
Carbon Dioxide ◽  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Cannula ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
End Tidal Carbon Dioxide ◽  
Carbon Dioxide Pressure ◽  
End Tidal

Background Obtaining accurate end-tidal carbon dioxide pressure measurements via nasal cannula poses difficulties in postanesthesia patients who are mouth breathers, including those who are obese and those with obstructive sleep apnea (OSA); a nasal cannula with an oral guide may improve measurement accuracy in these patients. The authors evaluated the accuracy of a mainstream capnometer with an oral guide nasal cannula and a sidestream capnometer with a nasal cannula that did or did not incorporate an oral guide in spontaneously breathing non-obese patients and obese patients with and without OSA during recovery from general anesthesia. Methods The study enrolled 20 non-obese patients (body mass index less than 30 kg/m) without OSA, 20 obese patients (body mass index greater than 35 kg/m) without OSA, and 20 obese patients with OSA. End-tidal carbon dioxide pressure was measured by using three capnometer/cannula combinations (oxygen at 4 l/min): (1) a mainstream capnometer with oral guide nasal cannula, (2) a sidestream capnometer with a nasal cannula that included an oral guide, and (3) a sidestream capnometer with a standard nasal cannula. Arterial carbon dioxide partial pressure was determined simultaneously. The major outcome was the arterial-to-end-tidal partial pressure difference with each combination. Results In non-obese patients, arterial-to-end-tidal pressure difference was 3.0 +/- 2.6 (mean +/- SD) mmHg with the mainstream capnometer, 4.9 +/- 2.3 mmHg with the sidestream capnometer and oral guide cannula, and 7.1 +/- 3.5 mmHg with the sidestream capnometer and a standard cannula (P &lt; 0.05). In obese non-OSA patients, it was 3.9 +/- 2.6 mmHg, 6.4 +/- 3.1 mmHg, and 8.1 +/- 5.0 mmHg, respectively (P &lt; 0.05). In obese OSA patients, it was 4.0 +/- 3.1 mmHg, 6.3 +/- 3.2 mmHg, and 8.3 +/- 4.6 mmHg, respectively (P &lt; 0.05). Conclusions Mainstream capnometry performed best, and an oral guide improved the performance of sidestream capnometry. Accuracy in non-obese and obese patients, with and without OSA, was similar.

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