subject: Can Bariatric Surgery Cure Sleep Apnea? [print this page] Can Bariatric Surgery Cure Sleep Apnea? Can Bariatric Surgery Cure Sleep Apnea?
In general, reliale nd sbstantial weght los, usually nt achieved by dietar mans, can be accmplished by bariatri surgey wth accompaning major reductins in associated co-morbidites. Two perative approaches are commonly performed: vertical-anded gatroplasty (VBG) and Roux-en-Y gastric bpass. The los of wight my e as uch as 100 to 150 pounds within a yea. Te mecanism of this weight los s twofold: decreased food intake, couled with its malabsorpton. This s bcause of the rduction in the sie f the stmach s well s the erouting of food to te small intestine whih reduces the calories and nutrients absorbed y the ody. In general, men weight los i greater after gastric bypass than after VBG.
Weight lss achieved y bariatric surger has ben repoted t e assocated with significant long-trm improvements in obstructive respiratry events, oxygenaton nd resolution of daytime somnolence. Bariatric surgery may significantly educe breathing interruptions during slep, and reduce snorng. A pssible mechanim for amelioration of symptoms i that eight loss is assoiated with a reducton in pper irway collasibility nd tht resolution of sleep apnea depends on the asolute vlue to which the uppr arway critical pressure falls.
Th AASM reommends bariatrc surgery s an optonal treatment fo sevee obesity and sleep apnea . It is, however, mandatry that the surgical odalities e used nly in association with a first-lne treatment sch as CPAP.
To clinically diagnos OSA and defin its seerity, thogh, slee mdicine doctors ue the "apnea-hypoxi index" nd those with mild OSA have 5-14 episods of apnea-hypoxia n hour, wile OSA i sid t e sevee if the number f apna-hypoxic episodes per our xceeds 30. There are no clar ut guidelines for determining which patients of OSA ar ideal candidates for briatric surgery.
Sleep apnea is on of th criteria used to suport te 'medical necesity' of bariatrc surgeies, even those with moderte obesity (BMI=35) cold e candidate f thei surgeon is onvinced tat they have "srious besity-related morbidity, suc s obtructive sleep apnea." Therefore, if urgery s considered, th patient should be evaluated y ultidisciplinary tem tat incorporates medial, nutritonal, and psychologial care nd proper counseling regarding ts ris benefit ratio.
A sstematic rview and meta-analysis of total of 22,094 patients revaled that obstrutive sleep apnea wa resolvd in 85.7% of patients, nd ws partially resolved or improed in 83.6% of patients undergoing baratric urgery.
N long-tem outome data exst t clearl demarcate ho mch of reducton n the AHI o CPAP pressures s reqired t result in meaningful reductions in symptms and co-morbidities related to OSA. A pe researhers, very small minrity of patients actually experience reolution of ostructive vents even after sustined wight lss and many continue to require CPAP therapy. In fact many ptients reported no amelioration f symptos like somnlence and snoring. It lso has t e entioned that in the long run, there are cass of recurence of sleep apnea withut concomitant weight increase.
Until te imact of sugical weight lss is bettr dfined, patients should nderstand that they are likely to continue to equire tretment fr OSA. Patients and healthcare practitiones alike shold recognize that reliance n bariatric surgey s 'ure' for OSA ay lead t n inappropriate cesstion of CPAP therapy.
It i strongly recommnded that CPAP e adminitered t tese patients before surger. Emiric CPAP at 10 cm H2O can b considered fo those patints wh cannt complete polysomnography, and th patient should contine t receive CPAP until broad weigt reduction has ben achieved. Especially during the mmediate postoperative peiod, CPAP may be needed t rotect the uppr airay untl sedative nd muscle-relaxing dugs hav been metabolized. Th imprtance f long term, mticulous follow up of thse patients cannot be over emphasied.
It s essential t keep in mind tat surgical weight lss alone cannot cue OSA, although it doe tend to rduce the severty of disease and my lower CPAP prssures equired to prevent apneic events.
Untl randmized controlled trials rove its efficacy irrevocably, and moe definitive guideline for sutability of candidates ae laid down, th ue of bariatric surgery t ure sleep apnea reains largely mpirical.
