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

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

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.

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. 

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