Obstructive Sleep Apnoea (OSA) patterns in bariatric surgical practice and response of OSA to weight loss after laparoscopic adjustable gastric banding (LAGB)

Department of Surgery, Department of Surgery, Alexandra Hospital, Singapore.
Annals of the Academy of Medicine, Singapore (Impact Factor: 1.15). 07/2009; 38(7):587-7.
Source: PubMed

ABSTRACT This study aims to evaluate the incidence of Obstructive Sleep Apnoea (OSA) in severely obese Asians and to study the impact of weight loss on OSA.
We report the results of routine preoperative Polysomnograms in 350 Asian patients undergoing bariatric surgery in our institute. Polysomnograms were repeated in 75 randomly selected patients with moderate to severe OSA after target weight loss with the laparoscopically placed adjustable gastric band (LAGB).
The prevalence of OSA in obese Asians is high. Moderate OSA was found in 46% of patients and severe OSA was found in 33%. Severe OSA was significantly more in the Chinese (46%) compared to the Malays (29%) or Indians (21%) (P = 0.035). We identified other risk factors for severe OSA (male sex, higher body mass index and the presence of hypertension) but were unable to select identifying parameters for very low (<5%) likelihood of severe OSA such that routine sleep studies prior to bariatric surgery could be omitted. Apnoea Hypoapnoea Index (AHI) showed improvement of 50% at 20 kg excess weight loss with the cure of OSA in preoperatively severe cases (P <0.005). Mild to moderate cases reported similar improvements although a direct correlation could not be established. Desaturation events, apnoea episodes, work of breathing and subjective assessment of sleepiness scores and quality of life (QOL) showed improving trends, albeit not statistically significant. Similar improvements were seen in sleep architecture with increased rapid eye movement (REM) and stage 3 sleep.
The incidence of OSA in Asians undergoing bariatric surgery is high. Routine sleep studies in Asian patients are justified. Weight loss brought about a significant improvement in AHI and continuous positive airway pressure requirements. LAGB placement should be considered a broadly effective therapy for sleep apnoea in the severely obese patient.

Download full-text


Available from: Anil D Rao, Jul 12, 2014
6 Reads
  • Source
    • "The LAGB procedure entails placement of a band around the proximal stomach forming a pouch with a narrow outlet just distal to the gastrooesophageal junction. The degree of restriction can be altered by inflating or deflating a balloon within the band with saline via a subcutaneous port [62, 63]. In RYGB surgery, the proximal stomach is transected forming a small gastric pouch which is joined to the roux limb of jejunum with the result that the more distal stomach, the complete duodenum, and proximal jejunum are bypassed [62]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obstructive sleep apnoea (OSA) syndrome is common, and obesity is a major risk factor. Increased peripharyngeal and central adiposity result in increased pharyngeal collapsibility, through increased mechanical loading around the upper airway, reduced tracheal traction on the pharynx, and reduced neuromuscular activity, particularly during sleep. Significant and sustained weight loss, if achieved, is likely to be a useful therapeutic option in the management of OSA and may be attempted by behavioural, pharmacological, and surgical approaches. Behavioural therapy programs that focus on aspects such as dietary intervention, exercise prescription patients and general lifestyle counselling have been tested. Bariatric surgery is an option in the severely obese when nonsurgical measures have failed, and laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass are the most commonly employed techniques in the United Kingdom. Most evidence for efficacy of surgery comes from cohort studies. The role of sibutramine in OSA in the obese patients has been investigated, however, there are concerns regarding associated cardiovascular risk. In this paper the links between obesity and OSA are discussed, and the recent studies evaluating the behavioural, pharmacological and surgical approaches to weight loss in OSA are reviewed.
    01/2012; 2012(1):163296. DOI:10.1155/2012/163296
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The public health impact of obstructive sleep apnoea (OSA) is increasingly recognised and will rise in conjunction with the obesity epidemic. Current clinical management of OSA focuses on device-based interventions, which do not correct underlying obesity. Various approaches to weight loss have been tested, including diet and behavioural modification programmes, pharmacological inter-ventions and bariatric surgery. Emergent clinical trials demonstrate that intensive diet and behavioural interventions can reduce weight, and this will substantively reduce OSA severity. However, there is little long-term or subgroup data. Pharmacological interventions alone provide minimal weight loss and potentially unacceptable side-effect profiles as high-lighted by the recent withdrawal of sibutramine. Bariatric surgery can markedly reduce obesity and is an effective OSA treatment but there is little good-quality long-term outcome data specific to OSA. The relative effectiveness and safety profiles of various bariatric surgeries, pharmacotherapies or behavioural/diet interventions either in combination or in comparison are unstudied. The multi-comorbidity of OSA lends itself to a multi-disciplinary approach incorporating dieticians, physiothera-pists, psychologists, exercise physiologists, sleep physicians and surgeons.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cardiovascular diseases are the leading cause of death among adults in developed countries. An increase in prevalent cardiovascular risk factors (e.g., obesity, hypertension and diabetes) has led to a concerted effort to raise awareness of the need to use evidence-based strategies to help patients at risk of developing cardiovascular disease and to reduce their likelihood of suffering a stroke. Sleep apnea has emerged as an important risk factor for the development of cardiovascular disease. Epidemiologic and clinical evidence has prompted the American Heart Association to issue a scientific statement describing the need to recognize sleep apnea as an important target for therapy in reducing cardiovascular disease risks. This article examines evidence supporting associations of sleep apnea with cardiovascular disease and considers evidence suggesting cardiovascular risk reductions through sleep apnea treatment. Perspectives on emerging therapeutic approaches and promising areas of clinical and experimental research are also discussed.
    Expert Review of Cardiovascular Therapy 07/2010; 8(7):995-1005. DOI:10.1586/erc.10.55
Show more