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


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.

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    • "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]. "
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