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

Aug 5, 2009Annals of the Academy of Medicine, Singapore

Patterns of Obstructive Sleep Apnea in Weight Loss Surgery and How It Changes After Adjustable Stomach Banding

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Abstract

The prevalence of obstructive sleep apnoea (OSA) in severely obese Asians is high, with moderate OSA found in 46% and severe OSA in 33% of patients.

Severe OSA is significantly more prevalent in Chinese patients (46%) compared to Malays (29%) or Indians (21%).
Male sex, higher body mass index, and the presence of hypertension are associated with an increased risk of severe OSA.
Weight loss of 20 kg is linked to a 50% improvement in the Apnoea Hypoapnoea Index (AHI) in preoperatively severe OSA cases.
Improvements in desaturation events, apnoea episodes, work of breathing, and subjective sleepiness scores were observed, though not statistically significant.
Weight loss also led to better sleep architecture, including increased rapid eye movement (REM) and stage 3 sleep.

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INTRODUCTION: 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.

MATERIALS AND METHODS: 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).

RESULTS: 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.

CONCLUSIONS: 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.

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

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