1
|
Matarredona Quiles S, Carrasco Llatas M, Martínez Ruíz de Apodaca P, Díez Ares JÁ, Navarro Martínez S, Dalmau Galofre J. Prevalence of obstructive sleep apnea in obese patients candidates for bariatric surgery and predictive questionnaires. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024:S2173-5735(24)00065-6. [PMID: 38908791 DOI: 10.1016/j.otoeng.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/10/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION AND OBJECTIVES Obstructive sleep apnea (OSA) is a prevalent condition among electable to bariatric surgery obese patients, often remaining underdiagnosed, thereby increasing surgical risk. The main purpose was to determine prevalence of OSA among candidates for bariatric surgery and to assess the rate of underdiagnosis of this condition. Additionally, the study aimed to evaluate the specific performance of three sleep questionnaires and scales (Excessive Daytime Sleepiness Scale (EDSS), Epworth Sleepiness Scale (ESS), and STOP-Bang) in these patients. METHODS A longitudinal, prospective, single-cohort study, with consecutive sampling including patients aged 18-65 years with obesity grade II (body mass index (BMI) ≥ 35 kg/m2) and hypertension, type 2 diabetes, metabolic syndrome or OSA or obesity grade III or IV (BMI ≥ 40 kg/m2) elective for bariatric surgery. Patients were evaluated at the Otorhinolaryngology department with an anamnesis regarding OSA including the administration of three sleep questionnaires (EDSS, ESS, and STOP-Bang), followed by cardiorespiratory polygraphy (CRP) for sleep evaluation. RESULTS 124 patients were included in this study. While 74.2% of the sample exhibited OSA on CRP, only 28.2% had a prior diagnosis. The STOP-Bang questionnaire demonstrated the highest sensitivity (93.3%) for detecting moderate to severe OSA, although with low specificity (33.8%). EDSS and ESS did not show a significant association with the presence of OSA. CONCLUSIONS OSA screening is crucial in candidates for bariatric surgery due to its high prevalence and low diagnosis rate. The STOP-Bang questionnaire may serve as a useful tool for identifying patients at risk of moderate to severe OSA and optimizing sleep assessments. However, further research is necessary to validate its utility in this specific population.
Collapse
Affiliation(s)
| | | | | | - Jose Ángel Díez Ares
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Sergio Navarro Martínez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Doctor Peset, Valencia, Spain
| | - José Dalmau Galofre
- Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, Spain
| |
Collapse
|
2
|
Peromaa-Haavisto P, Luostarinen M, Juusela R, Tuomilehto H, Kössi J. Obstructive Sleep Apnea: The Effect of Bariatric Surgery After Five Years-A Prospective Multicenter Trial. Obes Surg 2024; 34:1544-1551. [PMID: 38457003 PMCID: PMC11031458 DOI: 10.1007/s11695-024-07124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The prevalence of obstructive sleep apnea (OSA) is high among the bariatric surgery candidates. Obesity is the most important individual risk factor for OSA. The aim of this study was to investigate the effect of a laparoscopic Roux-en-Y gastric bypass (LRYGB) on OSA 5 years after the surgery. PATIENTS AND METHODS In this prospective multicenter study, standard overnight cardiorespiratory recording was conducted to 150 patients at baseline prior to bariatric surgery. A total of 111 (73.3%) patients of those had OSA. Cardiorespiratory recordings at 5 years after surgery were available for 70 OSA patients. The changes in anthropometric and demographic measurements including age, weight, body mass index (BMI), and waist and neck circumference were evaluated. Also, a quality of life (QoL) questionnaire 15D administered in a baseline was controlled at 5-year follow-up visit. RESULTS At 5-year OSA was cured in 55% of patients, but moderate or severe OSA still persisted in 20% of patients after operation. Mean total AHI decreased from 27.8 events/h to 8.8 events/h (p < 0.001) at 5-year follow-up. A clinically significant difference in QoL was seen in mobility, breathing, sleeping, usual activities, discomfort and symptoms, vitality and sexual activity. The QoL total score improved more in OSA patient at 5-year follow-up. CONCLUSIONS LRYGB is an effective treatment of OSA in obese patients and the achieved beneficial outcomes are maintained at 5-year follow-up.
Collapse
Affiliation(s)
- Pipsa Peromaa-Haavisto
- Department of Surgery, Tampere University Hospital Hatanpää, PL2000, FIN-33521, Tampere, Finland.
| | | | | | | | - Jyrki Kössi
- Päijät-Häme Central Hospital, 15850, Lahti, Finland
| |
Collapse
|
3
|
Eymard F, Aron-Wisnewsky J. Osteoarthritis in patients with obesity: The bariatric surgery impacts on its evolution. Joint Bone Spine 2024; 91:105639. [PMID: 37734439 DOI: 10.1016/j.jbspin.2023.105639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
Obesity is one of the main modifiable risk factors for osteoarthritis (OA). Moreover, obesity is associated with greater pain intensity and functional limitation, but also with a significantly lower responder rate to intra-articular treatments. Consequently, an arthroplasty is indicated earlier and more frequently in patients with obesity. However, pain and functional symptoms improve slightly less after arthroplasty in patients with obesity, who display higher incidence of early and late complications following prosthetic surgery. Bariatric surgery (BS) has increased worldwide and is efficient to induce major and sustainable weight-loss. Importantly, BS significantly reduces pain and functional limitation in patients with symptomatic knee OA. Biomarkers analysis also revealed a decrease in catabolic factors and an increase in anabolic one after BS suggesting a structural protective effect in knee OA. Nevertheless, the impact of BS prior to arthroplasty remains unclear. BS seems to decrease short- and mid-term complications such as infections or thrombosis. However, BS does not appear to modify long-term complications rate, and may even increase it, especially revisions and infections. Although few studies have compared the symptomatic and functional outcomes of joint replacement with or without BS, these are not significantly improved by prior BS. Despite these heterogeneous results, medico-economic studies found that BS prior to arthroplasty was cost-effective. To conclude, BS could significantly reduce the symptoms of OA and potentially slow its progression, but appears more disappointing in preventing long-term complications of arthroplasties and improving their functional results.
Collapse
Affiliation(s)
- Florent Eymard
- Department of Rheumatology, Henri-Mondor University Hospital, Assistance publique-Hôpitaux de Paris, AP-HP, 1, rue Gustave-Eiffel, 94000 Créteil, France.
| | - Judith Aron-Wisnewsky
- Department of Nutrition, Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, AP-HP, 75013 Paris, France; Sorbonne université, Inserm, Nutrition and Obesity: Systemic Approaches, NutriOmics, 75013 Paris, France
| |
Collapse
|
4
|
Demaeyer N, Bruyneel M. Factors Associated with Persistent Obstructive Sleep Apnea After Bariatric Surgery: A Narrative Review. Nat Sci Sleep 2024; 16:111-123. [PMID: 38348054 PMCID: PMC10859698 DOI: 10.2147/nss.s448346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45-70%. However, weight loss obtained by bariatric surgery is not always associated with full remission of OSA, suggesting that other confounding factors are present. This article aims to review the current literature, focusing on factors that could predict the persistence of OSA after bariatric surgery. For this purpose, relevant studies of more than 50 patients that assessed pre- and post-operative presence and severity of OSA detected by poly(somno)graphy (PG/PSG) in bariatric populations were collected. Six retrospective and prospective studies were evaluated that included 1302 OSA patients, with a BMI range of 42.6 to 56 kg/m2, age range of 44.8 to 50.7 years, and percentage of women ranging from 45% to 91%. The studies were very heterogeneous regarding type of bariatric surgery, diagnostic criteria for OSA and OSA remission, and delay of OSA reassessment. OSA remission was observed in 26% to 76% of patients at 11-12 months post-surgery. Loss to follow-up was high in all studies, leading to a potential underestimation of OSA remission. Based on this limited sample of bariatric patients, age, pre-operative OSA severity, proportion of weight loss, and type 2 diabetes (T2D) were identified as factors associated with OSA persistence but the results were inconsistent between studies regarding the impact of age and the magnitude of weight loss. Several other factors may potentially lead to OSA persistence in the bariatric surgery population, such as fat distribution, ethnicity, anatomical predisposition, pathophysiological traits, supine position, and REM-predominant hypopnea and apnea. Further well-conducted multicentric prospective studies are needed to document the importance of these factors to achieve a better understanding of OSA persistence after bariatric surgery in obese patients.
Collapse
Affiliation(s)
- Nathalie Demaeyer
- Department of Pneumology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Bruyneel
- Department of Pneumology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
- Department of Pneumology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
5
|
Qin H, Wang Y, Chen X, Steenbergen N, Penzel T, Zhang X, Li R. The efficacy of bariatric surgery on pulmonary function and sleep architecture of patients with obstructive sleep apnea and co-morbid obesity: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:1444-1457. [PMID: 37673709 DOI: 10.1016/j.soard.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 09/08/2023]
Abstract
Obstructive sleep apnea (OSA) is highly prevalent in patients with morbid obesity. There is a growing interest in the role of bariatric surgery in OSA management. This study aims to evaluate the therapeutic efficacy of bariatric surgery on changes in pulmonary function and sleep architecture. Studies of patients with OSA that underwent bariatric surgery were searched in 4 different databases (PubMed, Cochrane, Web of Science, and Embase) until October 31, 2022. We identified studies evaluating the efficacy of surgical intervention on primary outcomes (body mass index [BMI] and apnea-hypopnea index [AHI]) and secondary outcomes such as forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, oxygen desaturation index (ODI), T90, mean oxygen saturation (SpO2), nadirSpO2, sleep efficiency (SE), N1%, N2%, N3%, rapid eye movement (REM%), arousal index, Epworth sleepiness scale (ESS), neck circumference, waist circumference, and weight. A total of 24 eligible studies were finally chosen. Risk of bias assessed through funnel plots was collected and analyzed via random effects meta-analyses. There were significant reductions in BMI and AHI after bariatric surgery induced weight loss. Accordingly, improvement in FVC, meanSpO2, nadirSpO2, SE, N3%, REM%, and ESS were observed compared with baseline. Patients with OSA also exhibit lower ODI, T90, arousal index, neck circumference, waist circumference, and weight after treatment. Bariatric surgery has beneficial effects on patients with OSA and obesity, particularly with morbid obesity. Surgical weight loss significantly eliminates apnea-hypopnea events, reduces weight, increases oxygen saturation, N3 and REM sleep stage, reduces sleep fragmentation, and improves pulmonary functions with augmented FVC.
Collapse
Affiliation(s)
- Hua Qin
- Department of Otolaryngology, Head & Neck Surgery, Laboratory of ENT-HNS Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Yuan Wang
- Respiratory Department, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Chen
- Musculoskeletal Research Laboratory, Department of Orthopedics & Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Nicolas Steenbergen
- Imperial College London Department of Bioengineering, London, United Kingdom
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Xiaowen Zhang
- Department of Otolaryngology, Head & Neck Surgery, Laboratory of ENT-HNS Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Renjie Li
- Center for Bariatric and Metabolic Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany.
| |
Collapse
|
6
|
Al Oweidat K, Toubasi AA, Tawileh RBA, Tawileh HBA, Hasuneh MM. Bariatric surgery and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath 2023; 27:2283-2294. [PMID: 37145243 DOI: 10.1007/s11325-023-02840-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Several studies evaluated the effect of bariatric surgery on obstructive sleep apnea (OSA) but findings have been inconsistent. The aim of this study was to conduct an updated systematic review and meta-analysis to investigate the effect of bariatric surgery on OSA. METHODS The databases for PubMed, CENTRAL, and Scopus were searched up to the 1st of December, 2021. Studies were included if they were cohort or case-control in design, included patients with diagnosis of OSA, the patients underwent any bariatric surgery, and the study performed postoperative polysomnography. RESULTS The total number of the included patients was 2310 patients with OSA from 32 studies. Our analysis showed that bariatric surgery was associated with significant reduction in BMI (WMD = - 11.9, 95%CI: - 13.4, - 10.4), apnea-hypopnea index (AHI) (WMD = - 19.3, 95%CI: - 23.9, - 14.6), and respiratory disturbance index (RDI) (WMD = - 33.9, 95%CI: - 42.1, - 25.7). The rate of OSA remission after the surgery was 65% (95%CI: 0.54, 0.76). CONCLUSION Our results suggest that bariatric surgeries are effective in reducing obesity among patients with OSA in addition to OSA severity measures. However, the low rate of OSA remission suggests that the main etiology of OSA is not only obesity but also includes other important variables such as the anatomy of the jaw.
Collapse
Affiliation(s)
- Khaled Al Oweidat
- Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad A Toubasi
- Faculty of Medicine, The University of Jordan, Amman, 11942, Jordan.
| | | | | | - Manar M Hasuneh
- Faculty of Medicine, The University of Jordan, Amman, 11942, Jordan
| |
Collapse
|
7
|
Gangitano E, Martinez-Sanchez N, Bellini MI, Urciuoli I, Monterisi S, Mariani S, Ray D, Gnessi L. Weight Loss and Sleep, Current Evidence in Animal Models and Humans. Nutrients 2023; 15:3431. [PMID: 37571368 PMCID: PMC10420950 DOI: 10.3390/nu15153431] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Sleep is a vital process essential for survival. The trend of reduction in the time dedicated to sleep has increased in industrialized countries, together with the dramatic increase in the prevalence of obesity and diabetes. Short sleep may increase the risk of obesity, diabetes and cardiovascular disease, and on the other hand, obesity is associated with sleep disorders, such as obstructive apnea disease, insomnia and excessive daytime sleepiness. Sleep and metabolic disorders are linked; therefore, identifying the physiological and molecular pathways involved in sleep regulation and metabolic homeostasis can play a major role in ameliorating the metabolic health of the individual. Approaches aimed at reducing body weight could provide benefits for both cardiometabolic risk and sleep quality, which indirectly, in turn, may determine an amelioration of the cardiometabolic phenotype of individuals. We revised the literature on weight loss and sleep, focusing on the mechanisms and the molecules that may subtend this relationship in humans as in animal models.
Collapse
Affiliation(s)
- Elena Gangitano
- OCDEM Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford OX3 7LE, UK
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Noelia Martinez-Sanchez
- OCDEM Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford OX3 7LE, UK
| | | | - Irene Urciuoli
- Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
| | - Stefania Monterisi
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Stefania Mariani
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - David Ray
- OCDEM Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford OX3 7LE, UK
| | - Lucio Gnessi
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| |
Collapse
|
8
|
Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
Collapse
Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Halvachizadeh S, Muller D, Baechtold M, Hauswirth F, Probst P, Muller MK. Bariatric metabolic surgery eliminates body mass index as a risk factor for unemployment. Surg Obes Relat Dis 2023; 19:356-363. [PMID: 36424328 DOI: 10.1016/j.soard.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/26/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The effects of bariatric metabolic surgery (BMS) on health and comorbidities are well-known. Socioeconomic factors have been increasingly in focus in recent investigations. OBJECTIVE The aim of this study was to analyze the effects of BMS on predictive variables for unemployment. SETTING This study as performed in one reference center for BMS. Patients were treated between 2011 and 2017. METHODS The study design was a retrospective cohort study. Inclusion criteria were Roux-en-Y gastric bypass surgery, follow-up of 60 months, and complete data on employment rate. Exclusion criteria were secondary BMS, secondary referral, loss of follow-up, or patients aged 60 years and above. Patients were stratified as employed independent of part-time work and as unemployed if the patient had no current employment at the time of the visit. Follow-up visits were performed after 6, 12, 24, 48, and 60 months. RESULTS This study included 623 patients; prior to BMS, 239 (38.36%) patients were employed and 384 (61.64%) unemployed. Risk factors for baseline unemployment included increased body mass index (BMI) (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01 to 1.05; P = .010) and increased American Society of Anesthesiology (ASA) score (OR, 3.55; 95% CI, 2.56 to 4.90; P < .001). Unemployment rate dropped to 32.4% after 24 months (P < .001) and increased to 62.8% after 60 months. The BMI continuously decreased. Following BMS, the unemployment rate was no longer associated with BMI (24 months: OR, 0.97; 95% CI, 0.95 to 1.01; P = .220; 60 months: 1.04; 95% CI, 0.97 to 1.11; P = .269). The initial ASA status remained associated with unemployment (OR, 2.20; 95% CI, 1.60 to 3.01; P < .001). CONCLUSION BMI showed some association with the unemployment rate prior to BMI. The unemployment rate significantly decreased 24 months after BMS but increased to baseline values after 60 months. Following BMS, BMI was no longer associated with unemployment.
Collapse
Affiliation(s)
- Sascha Halvachizadeh
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Frauenfeld, Switzerland.
| | - Domink Muller
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Frauenfeld, Switzerland
| | - Matthias Baechtold
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Frauenfeld, Switzerland
| | - Fabian Hauswirth
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Frauenfeld, Switzerland
| | - Pascal Probst
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Frauenfeld, Switzerland
| | - Markus K Muller
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Frauenfeld, Switzerland
| |
Collapse
|
10
|
Ardiles LG. Obesity and renal disease: Benefits of bariatric surgery. Front Med (Lausanne) 2023; 10:1134644. [PMID: 36926320 PMCID: PMC10011092 DOI: 10.3389/fmed.2023.1134644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/25/2023] [Indexed: 03/04/2023] Open
Abstract
The prevalence of obesity, a preventable and reversible condition with a high impact on health, continues to rise, especially after the COVID-19 pandemic. Severe overweight is well recognized as a risk factor for diabetes and hypertension, among other conditions, that may increase cardiovascular risk. Obesity has grown simultaneously with a rise in the prevalence of chronic kidney disease, and a pathophysiological link has been established, which explains its role in generating the conditions to facilitate the emergence and maximize the impact of the risk factors of chronic kidney disease and its progression to more advanced stages. Knowing the mechanisms involved and having different tools to reverse the overweight and its consequences, bariatric surgery has arisen as a useful and efficient method, complementary or alternative to others, such as lifestyle changes and/or pharmacotherapy. In a detailed review, the mechanisms involved in the renal consequences of obesity, the impact on risk factors, and the potential benefit of bariatric surgery at different stages of the disease and its progression are exposed and analyzed. Although the observational evidence supports the value of bariatric surgery as a renoprotective measure in individuals with obesity, diabetic or not, randomized studies are expected to establish evidence-based recommendations that demonstrate its positive risk-benefit balance as a complementary or alternative therapeutic tool.
Collapse
Affiliation(s)
- Leopoldo G Ardiles
- Department of Nephrology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| |
Collapse
|
11
|
Effect of positive pressure ventilation and bariatric surgery on extracellular vesicle microRNAs in patients with severe obesity and obstructive sleep apnea. Int J Obes (Lond) 2023; 47:24-32. [PMID: 36284205 DOI: 10.1038/s41366-022-01230-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) and severe obesity share a common pathophysiological phenomenon, systemic and tissue hypoxia. Hypoxaemia modifies microRNA expression, particularly, extracellular vesicles microRNAs which are involved in the progression of cardiovascular diseases, metabolic syndrome and cancer. We aim to evaluate extracellular vesicle miRNAs among patients with severe obesity with and without OSA and the effect of OSA and severe obesity treatment: continuous positive airway pressure (CPAP) and bariatric surgery. METHODS Patients were selected from the Epigenetics Modification in Morbid Obesity and Obstructive Sleep Apnea (EPIMOOSA) study (NCT03995836), a prospective observational study of patients undergoing bariatric surgery. Patients were divided into OSA (Apnea-hyponea index (AHI) > 10) and non-OSA (AHI < 10). Patients with OSA were treated with CPAP for 6 months. Then, all patients had bariatric surgery and re-evaluated 12 months later. At each visit, blood samples were obtained for biobanking. Subsequently, extracellular vesicles were extracted, and then, miRNA expression was analysed. RESULTS 15 patients with OSA and 9 without OSA completed the protocol. At baseline, patients with OSA showed higher miR16, miR126 and miR320 (p < 0.05) and lower miR223 expression (p < 0.05) than those without OSA. In patients with severe obesity and OSA, after 6 months with CPAP, we observed a significant decrease in miR21 (p < 0.01), miR126 (p < 0.001) and miR320 (p < 0.001), with no changes in any miRNA in patients without OSA. No changes were detected in any miRNA after 6 months of bariatric surgery in patients with or without OSA. CONCLUSION Co-existance of OSA and severe obesity alters the profile of extracellular vesicle miRNAs. Bariatric surgery and weight loss did not reverse this effect meanwhile the treatment with CPAP in patients with severe obesity and OSA showed a recovery outcome in those extracellular vesicle miRNAs. Those facts remark the need for OSA screening in patients with severe obesity. CLINICAL TRIAL REGISTRATION The study has also been registered at ClinicalTrials.gov identifier: NCT03995836.
Collapse
|
12
|
Taher MM, Abdalqader MA, Jahanath S, Paramasivam P, Gendeh HS. Bariatric surgeries: Outcome throughout an annum at a specialist center in Malaysia. PLoS One 2023; 18:e0285196. [PMID: 37159461 PMCID: PMC10168565 DOI: 10.1371/journal.pone.0285196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/17/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION Malaysia has the highest number of obese and overweight individuals in South-east Asia. The 2019 National Health & Morbidity survey found 50.1% of Malaysians to be overweight or obese with 30.4% being overweight and 19.7% being obese. This has led to the high rise of the bariatric surgeries demand and needs within the nation. AIM & OBJECTIVES To assess the level of fasting blood sugar (FBS), systolic, diastolic blood pressure, stop BANG score for obstructive sleep apnoea (OSA) and BMI (Body Mass Index) for the patients before and after bariatric surgeries (sleeve/gastric bypass) for a one year follow up period. MATERIAL & METHODS The study was conducted among 1000 patients who underwent a single weight reduction surgery (sleeve/gastric bypass) by a single surgeon at the Cengild Medical Centre between January 2019 to January 2020. They were followed up for a one-year period through recording the parameters of fasting blood sugar (FBS), systolic, diastolic blood pressure, stop BANG score for obstructive sleep apnoea (OSA) and BMI (Body Mass Index). Study was conducted using universal sampling including all subjects visited the centre and a written consent was obtained from each participant. Descriptive statistics with mean was used and paired t-test was used for comparison and test the difference. The STOP-BANG acronym stands for: Snoring history, Tired during the day, Observed stop breathing while sleep, High blood pressure, BMI more than 35 kg/m2, Age more than 50 years, Neck circumference more than 40 cm and male Gender. RESULTS The mean age of patients was 38 years old. Mean FBS for the patients one month before the operation was 10.42 mmol/L and 5.84 three months post procedure. The systolic blood pressure one month before the operation and 3 months after was 139.81 mmHg and 123.79 mmHg, while diastolic blood pressure was 86.84 mmHg and 81.07 mmHg respectively. BMI was reduced from 39.69 to 27.99 after one year from the weight reduction operation. All the above parameters showed a significant reduction between one-month pre operation as compared to 3 months and 12 months post operation and that improved the health parameters of the patients significantly. CONCLUSION The weight reduction operations showed a significant reduction in the FBS, blood pressure, OSA scores and BMI at 3, 12 months after the operation These patients had better overall health after the significant reduction in these parameters.
Collapse
Affiliation(s)
- Mustafa Mohammed Taher
- Upper Gastrointestinal and Bariatric Surgery Department, Cengild Medical Centre, Bangsar South, Kuala Lumpur, Malaysia
| | - Mohammed A Abdalqader
- Community Medicine Department, University of Cyberjaya, Cyberjaya, Selangor, Malaysia
| | - Subhashini Jahanath
- Upper Gastrointestinal and Bariatric Surgery Department, Cengild Medical Centre, Bangsar South, Kuala Lumpur, Malaysia
| | | | - Hardip Singh Gendeh
- Otorhinolaryngology Department, UKM Medical Center, Bandar Tun Razak, Kuala Lumpur, Malaysia
| |
Collapse
|
13
|
Research progress on the role of exosomes in obstructive sleep apnea-hypopnea syndrome-related atherosclerosis. Sleep Med Rev 2022; 66:101696. [PMID: 36174425 DOI: 10.1016/j.smrv.2022.101696] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/30/2022] [Accepted: 09/11/2022] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease (CVD) is a leading cause of mortality worldwide. Atherosclerosis, a multifactorial disease with complicated pathogenesis, is the main cause of CVD, underlying several major adverse cardiovascular events. Obesity is the main cause of obstructive sleep apnea (OSA) and a significant risk for atherosclerosis. OSA is an independent risk factor for CVD. Recent research has focused on understanding the underlying molecular mechanisms by which OSA influences atherosclerosis pathogenesis. The role of exosomes in this process has attracted considerable attention. Exosomes are a type of extracellular vesicles (EV) that are released from many cells (both healthy and diseased) and mediate cell-to-cell communication by transporting microRNAs (miRNAs), proteins, mRNAs, DNA, or lipids to target cells, thereby modulating the functions of target cells and tissues. Intermittent hypoxia in OSA alters the exosomal carrier in circulation and promotes the permeability and dysfunction of endothelial cells, which have been associated with the pathogenesis of atherosclerosis. This review discusses the potential roles of exosomes and exosome-derived molecules in the development and progression of OSA-related atherosclerosis. Additionally, we explore the possible mechanisms underlying OSA-related atherosclerosis and provide new insights for the development of novel exosome-based therapeutics for OSA-related atherosclerosis and CVD.
Collapse
|
14
|
Pennings N, Golden L, Yashi K, Tondt J, Bays HE. Sleep-disordered breathing, sleep apnea, and other obesity-related sleep disorders: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 4:100043. [PMID: 37990672 PMCID: PMC10662058 DOI: 10.1016/j.obpill.2022.100043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides clinicians an overview of sleep-disordered breathing, (e.g., sleep-related hypopnea, apnea), and other obesity-related sleep disorders. Methods The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results Obesity contributes to sleep-disordered breathing, with the most prevalent manifestation being obstructive sleep apnea. Obesity is also associated with other sleep disorders such as insomnia, primary snoring, and restless legs syndrome. This CPS outlines the evaluation, diagnosis, and treatment of sleep apnea and other sleep disorders, as well as the clinical implications of altered circadian system. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on "Sleep-Disordered Breathing, Sleep Apnea, and Other Obesity-Related Sleep Disorders" is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity.
Collapse
Affiliation(s)
- Nicholas Pennings
- Chair and Associate Professor of Family Medicine, Campbell University School of Osteopathic Medicine, Buies Creek, NC, 27506, USA
| | - Leslie Golden
- Watertown Family Practice, Clinical Preceptor, University of Wisconsin Family Medicine Residency, Madison, WI, USA
| | - Kanica Yashi
- Division of Hospitalist Medicine, Bassett Healthcare Network, Assistant Clinical Professor of Medicine Columbia University, 1 Atwell Road, Cooperstown, NY, 13326, USA
| | - Justin Tondt
- Department of Family and Community Medicine, Penn State Health, Penn State College of Medicine 700 HMC Crescent Rd Hershey, PA, 17033, USA
| | - Harold Edward Bays
- Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
| |
Collapse
|
15
|
Combined Airway and Bariatric Surgery (CABS) for Obstructive Sleep Apnea Patients with Morbid Obesity: A Comprehensive Alternative Preliminary Study. J Clin Med 2022; 11:jcm11237078. [PMID: 36498653 PMCID: PMC9738588 DOI: 10.3390/jcm11237078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
Although continuous positive airway pressure is the gold standard for obstructive sleep apnea (OSA), it does not improve obesity. By contrast, bariatric surgery significantly improves obesity but with sustained OSA in the majority of patients. This study proposes a comprehensive technique—combined airway and bariatric surgery (CABS)—to improve both obesity and OSA. The aims of the study are to evaluate the feasibility, safety and efficacy of CABS in morbidly obese OSA patients. The retrospective study enrolled 20 morbidly obese OSA patients (13 males; median age, 44 years; median apnea−hypopnea index (AHI), 63.2 event/h; median body mass index (BMI), 41.4 kg/m2). The study population was divided into two groups based on patients’ volition after shared decision making. The bariatric surgery (BS) group included laparoscopic sleeve gastrectomy (LSG, n = 8) and laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 2). CABS involved bariatric surgery—LSG (n = 8) and LRYGB (n = 2) in conjunction with airway surgery (concurrent nasal/palatal/lingual surgery [n = 8], concurrent palatal/lingual surgery [n = 2]). Patients received a home sleep apnea test at baseline and one year after surgery. The two patient groups were not different in age, sex, preoperative AHI or preoperative BMI. There was no airway compromise, wound bleeding or infection throughout the postoperative period. One year after surgery, patients in both groups achieved significant improvement in AHI and BMI. Furthermore, the improvement in AHI was significantly higher (p = 0.04) in the CABS group than in the BS group despite the insignificant change in BMI reduction (p = 0.63) between the two groups. In the CABS group, the BMI dropped from 40.4 to 28.4 kg/m2 (p < 0.0001) and the AHI decreased from 75.1 to 4.5 event/h (p = 0.0004). The classic success rate for OSA was 90% and the cure rate was 60% in the CABS group. A perioperative assessment of CABS group patients also revealed a significant improvement in the Epworth sleepiness scale, minimal O2 saturation, snoring index and heart rate. CABS is feasible and safe in treating OSA with morbid obesity. CABS achieves more reduction in AHI than BS alone with high success and cure rates for OSA. CABS can also significantly improve quality of life and general health and offers a comprehensive alternative for morbidly obese OSA patients.
Collapse
|
16
|
Tan MM, Jin X, Taylor C, Low AK, Le Page P, Martin D, Li A, Joseph D, Kormas N. Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia. J Clin Med 2022; 11:4466. [PMID: 35956083 PMCID: PMC9369852 DOI: 10.3390/jcm11154466] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Real-world data on long-term (> 5 years) weight loss and obesity-related complications after newer bariatric surgical procedures are currently limited. The aim of this longitudinal study was to examine the effectiveness and sustainability of bariatric surgery in a cohort with clinically severe obesity in a multidisciplinary publicly funded service in two teaching hospitals in New South Wales, Australia. Methods: Patients were adults with complex clinically severe obesity with a BMI ≥ 35 kg/m2 and at least three significant obesity-related comorbidities, who underwent bariatric surgeries between 2009 and 2017. Detailed obesity-related health outcomes were reported from annual clinical data and assessments for up to 9 years of follow-up. Data were also linked with the national joint replacement registry. Results: A total of 65 eligible patients were included (mean, 7; range, 3−12 significant obesity-related comorbidities); 53.8% female; age 54.2 ± 11.2 years, with baseline BMI 52.2 ± 12.5 kg/m2 and weight 149.2 ± 45.5 kg. Most underwent laparoscopic sleeve gastrectomy (80.0%), followed by laparoscopic adjustable gastric banding (10.8%) and one anastomosis gastric bypass (9.2%). Substantial weight loss was maintained over 9 years of follow-up (p < 0.001 versus baseline). Significant total weight loss (%TWL ± SE) was observed (13.2 ± 2.3%) following an initial 1-year preoperative intensive lifestyle intervention, and ranged from 26.5 ± 2.3% to 33.0 ± 2.0% between 1 and 8 years following surgery. Type 2 diabetes mellitus (T2DM), osteoarthritis-related joint pain and depression/severe anxiety were the most common metabolic, mechanical and mental health comorbidities, with a baseline prevalence of 81.5%, 75.4% and 55.4%, respectively. Clinically significant composite cumulative rates of remission and improvement occurred in T2DM (50.0−82.0%) and hypertension (73.7−82.9%) across 6 years. Dependence on continuous positive airway pressure treatment in patients with sleep-disordered breathing fell significantly from 63.1% to 41.2% in 6 years. Conclusion: Bariatric surgery using an intensive multidisciplinary approach led to significant long-term weight loss and improvement in obesity-related comorbidities among the population with clinically complex obesity. These findings have important implications in clinical care for the management of the highest severity of obesity and its medical consequences. Major challenges associated with successful outcomes of bariatric surgery in highly complex patients include improving mental health in the long run and reducing postoperative opioid use. Long-term follow-up with a higher volume of patients is needed in publicly funded bariatric surgery services to better monitor patient outcomes, enhance clinical data comparison between services, and improve multidisciplinary care delivery.
Collapse
Affiliation(s)
- Michelle M.C. Tan
- Boden Initiative, Central Clinical School, Sydney School of Medicine, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia
- Diabetes, Metabolism & Obesity Translational Research Unit, Camden Hospital, South Western Sydney Local Health District, Camden, NSW 2570, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Xingzhong Jin
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, St Leonards, NSW 2064, Australia
| | - Craig Taylor
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
| | - Adrian K. Low
- Department of Orthopaedic Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia;
| | - Philip Le Page
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
| | - David Martin
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
- Hepatobiliary & Upper GIT Surgery Department, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Ang Li
- Boden Initiative, Central Clinical School, Sydney School of Medicine, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- NHMRC Centre of Research Excellence in Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - David Joseph
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
- Hepatobiliary & Upper GIT Surgery Department, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Nic Kormas
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia
- Diabetes, Metabolism & Obesity Translational Research Unit, Camden Hospital, South Western Sydney Local Health District, Camden, NSW 2570, Australia
| |
Collapse
|
17
|
Can Weight Loss Improve the Cardiovascular Outcomes of Patients with Obesity and Obstructive Sleep Apnea? HEARTS 2022. [DOI: 10.3390/hearts3020008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular events are the primary cause of mortality in patients with obstructive sleep apnea and obesity. The rising prevalence of obstructive sleep apnea in recent decades has been linked to increasing rates of obesity. Obstructive sleep apnea has also been linked with many different cardiovascular diseases including coronary artery disease, stroke, heart failure, hypertension, and atrial fibrillation. Obesity is an increasing health concern globally, in part because obesity complications such as hypertension, diabetes, and obstructive sleep apnea increase the risk of cardiovascular diseases. More than 10% weight loss may be required to prevent or reverse obesity complications. Treatment approaches to obesity include nutritional therapy, exercise therapy, pharmacotherapy, and surgical therapies. This review intends to identify the effects of weight loss on cardiovascular outcomes in patients with obesity and obstructive sleep apnea. Despite the strong association between cardiovascular diseases and obstructive sleep apnea, randomized trials have failed to demonstrate that treatment of obstructive sleep apnea reduces cardiovascular events, even in patients with established cardiovascular diseases. Weight loss in patients with obstructive sleep apnea improves HbA1c, systolic blood pressure, HDL cholesterol, and triglycerides, but thus far no changes in cardiovascular events have been shown. The combination of weight loss with continuous positive airway pressure (CPAP) appears more beneficial than either treatment in isolation. Large well-controlled trials in patients with obstructive sleep apnea to assess the effects of different weight reduction programs on cardiovascular disease are still needed.
Collapse
|
18
|
Mattila T, Hasala H, Kreivi HR, Avellan-Hietanen H, Bachour A, Herse F, Leskelä RL, Toppila-Salmi S, Erhola M, Haahtela T, Vasankari T. Changes in the societal burden caused by sleep apnoea in Finland from 1996 to 2018: A national registry study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 16:100338. [PMID: 35252943 PMCID: PMC8889373 DOI: 10.1016/j.lanepe.2022.100338] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background In the current century, sleep apnoea has become a significant public health problem due to the obesity epidemic. To increase awareness, improve diagnostics, and improve treatment, Finland implemented a national sleep apnoea programme from 2002 to 2010. Here, we present changes in the societal burden caused by sleep apnoea from 1996 to 2018. Methods National register data were collected from the Care Register for Health Care, Statistics Finland, the Social Insurance Institution of Finland, and the Finnish Centre for Pensions. Disease prevalence, use of healthcare and social services, and societal costs were estimated. Findings The number of sleep apnoea patients increased in secondary care from 8 600 in 1996 to 61 000 in 2018. There was a continuous increase in outpatient visits in secondary care from 9 700 in 1996 to 122 000 in 2018 (1 160%) and in primary care from 10 000 in 2015 to 29 000 in 2018 (190%). Accordingly, the cumulative annual number of days off work for sleep apnoea increased from 1 100 to 46 000. However, disability pensions for sleep apnoea decreased from 820 to 550 (33%) during the observation period. Societal costs per patient decreased over 50% during the observation period (€2 800 to €1 200). Interpretation The number of sleep apnoea patients in Finland increased remarkably during the observation period. To control this burden, diagnostic methods and treatment were revised and follow up was reorganised. Consequently, there was a significant decrease in societal costs per patient. The decrease in disability pensions suggests earlier diagnosis and improved treatment. The national sleep apnoea programme was one of the initiators for these improved outcomes. Funding The Finnish Institute for Health and Welfare and the Hospital District of Helsinki and Uusimaa (HUH), Helsinki, Finland.
Collapse
Affiliation(s)
- Tiina Mattila
- Department of Pulmonary Diseases, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Meilahti Triangle Hospital, 6 floor, PO Box 372, 00029 HUS, Helsinki, Finland
- Finnish Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland
- Corresponding author at: Helsinki University Hospital, Department of Pulmonary Diseases, Meilahti Triangle Hospital, 6th floor, PO Box 372, 00029 HUS, Helsinki, Finland.
| | - Hannele Hasala
- Department of Respiratory Medicine, Sleep Unit, Tampere University Hospital, PO Box 2000, 33521 Tampere, Finland
| | - Hanna-Riikka Kreivi
- Department of Pulmonary Diseases, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Meilahti Triangle Hospital, 6 floor, PO Box 372, 00029 HUS, Helsinki, Finland
| | - Heidi Avellan-Hietanen
- Department of Pulmonary Diseases, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Meilahti Triangle Hospital, 6 floor, PO Box 372, 00029 HUS, Helsinki, Finland
| | - Adel Bachour
- Department of Pulmonary Diseases, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Meilahti Triangle Hospital, 6 floor, PO Box 372, 00029 HUS, Helsinki, Finland
| | - Fredrik Herse
- Nordic Healthcare Group, Vattuniemenranta 2, 00210 Helsinki, Finland
| | | | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland, PO Box 160, 00290 Helsinki
- University of Helsinki, Helsinki, Finland
| | - Marina Erhola
- Päijät-Häme Joint Authority for Health and Welfare, Keskussairaalankatu 7, 15850 Lahti, Finland
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland, PO Box 160, 00290 Helsinki
- University of Helsinki, Helsinki, Finland
| | - Tuula Vasankari
- University of Turku, Department of Pulmonary Diseases and Clinical Allergology, PO Box 52, 20521 Turku, Finland
- Finnish Lung Health Association (FILHA), Sibeliuksenkatu 11 A 1, 00250 Helsinki, Finland
| |
Collapse
|
19
|
Abstract
Hypertension is a major cause of cardiovascular morbidity and mortality globally. Many patients with hypertension have secondary causes of hypertension that merit further evaluation. For example, secondary hypertension can result in target organ damage to the heart, kidneys, and brain independent of the effects of blood pressure. Several causes benefit from targeted therapies to supplement first-line antihypertensive agents. However, secondary hypertension is often underrecognized. The goal of this review is to highlight optimal approaches to the diagnosis and management of common causes of secondary hypertension, including primary aldosteronism, renovascular hypertension, obstructive sleep apnea, and drug-induced hypertension.
Collapse
Affiliation(s)
- Harini Sarathy
- Division of Nephrology and Hypertension, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA. https://twitter.com/hurryknee
| | - Liann Abu Salman
- Renal-Electrolyte and Hypertension Division, Renal Division, Perelman School of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Founders, Philadelphia, PA 19104, USA. https://twitter.com/LiannAbuSalman
| | - Christopher Lee
- Department of Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, 800 Spruce Street, Philadelphia, PA 19104, USA. https://twitter.com/LeetopherC
| | - Jordana B Cohen
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 831 Blockley, Philadelphia, PA 19104, USA; Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
20
|
Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, Barbé F, Borsini E, Caballero-Eraso C, Cano-Pumarega I, de Carlos Villafranca F, Carmona-Bernal C, Carrillo Alduenda JL, Chiner E, Cordero Guevara JA, de Manuel L, Durán-Cantolla J, Farré R, Franceschini C, Gaig C, Garcia Ramos P, García-Río F, Garmendia O, Gómez García T, González Pondal S, Hoyo Rodrigo MB, Lecube A, Antonio Madrid J, Maniegas Lozano L, Martínez Carrasco JL, Masa JF, Masdeu Margalef MJ, Mayos Pérez M, Mirabet Lis E, Monasterio C, Navarro Soriano N, Olea de la Fuente E, Plaza G, Puertas Cuesta FJ, Rabec C, Resano P, Rigau D, Roncero A, Ruiz C, Salord N, Saltijeral A, Sampol Rubio G, Sánchez Quiroga MÁ, Sans Capdevila Ó, Teixeira C, Tinahones Madueño F, Maria Togeiro S, Troncoso Acevedo MF, Vargas Ramírez LK, Winck J, Zabala Urionaguena N, Egea C. [Translated article] International consensus document on obstructive sleep apnea. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
21
|
Kent D, Stanley J, Aurora RN, Levine CG, Gottlieb DJ, Spann MD, Torre CA, Green K, Harrod CG. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2021; 17:2507-2531. [PMID: 34351849 PMCID: PMC8726364 DOI: 10.5664/jcsm.9594] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. RESULTS The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. CITATION Kent D, Stanley J, Aurora RN, et al. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.
Collapse
Affiliation(s)
- David Kent
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - R. Nisha Aurora
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Daniel J. Gottlieb
- VA Boston Healthcare System, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Carlos A. Torre
- University of Miami, Miller School of Medicine, Miami, Florida
| | | | | |
Collapse
|
22
|
Qureshi FG, Wiegand JG, O'Neill G, Allen B, Wools G, Klement J, Franklin EV, Messiah SE, Gupta OT. Longitudinal Outcomes in Adolescents After Referral for Metabolic and Bariatric Surgery. J Pediatr Gastroenterol Nutr 2021; 73:677-683. [PMID: 34433784 DOI: 10.1097/mpg.0000000000003290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) can be a well tolerated and effective treatment option for severe obesity in adolescents. We compared outcomes for adolescents that did and did not proceed to surgery. METHODS A single-center longitudinal study (2015-2020). Patients were identified as LSG if they completed laparoscopic sleeve gastrectomy within 6 months of initial visit and NoLSG if they did not. Chi-square, Fisher exact, nonparametric Kruskal-Wallis tests, and Linear Mixed Models (LMM) were used to compare outcomes over 2 years. RESULTS Three hundred fifty-two adolescents were referred with a mean age of 15.6 ± 1.4, 69% girls, 38% Hispanic, and 78% had noncommercial insurance. The median baseline weight was 135 kg and body mass index (BMI) was 48 kg/m2; 42% had a BMI >50. Seventy-nine (22%) underwent LSG whereas 273 (78%) did not complete MBS primarily because of lack of interest. LSG patients had 21% total weight loss and 22% total BMI loss at 24 months whereas NoLSG patients had 4% total weight gain and 3% BMI gain (P < 0.01). Obesity-associated conditions improved in the LSG group (P < 0.01). Follow-up in both groups was poor (≤30% at 24 months). Patients with public insurance and those with BMI from 50 to 59.9 kg/m2 were high performing LSG patients. CONCLUSIONS A minority (22%) of adolescents referred for MBS proceeded to surgery, despite its demonstrated efficacy and safety in adolescence. Those that did not undergo surgery continued to gain weight. Further research is needed to understand patient preferences or concerns related to MBS utilization during adolescence.
Collapse
Affiliation(s)
- Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center
- Childrens Health System of Texas
| | - Jared G Wiegand
- University of Texas Health Science Center, School of Public Health, Dallas
| | | | | | | | | | | | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas
| | - Olga T Gupta
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
23
|
Kobuch S, Tsang F, Chimoriya R, Gossayn D, O’Brien S, Jamal J, Laks L, Tahrani A, Kormas N, Piya MK. Obstructive sleep apnoea and 12-month weight loss in adults with class 3 obesity attending a multidisciplinary weight management program. BMC Endocr Disord 2021; 21:227. [PMID: 34774056 PMCID: PMC8590787 DOI: 10.1186/s12902-021-00887-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although there is a strong association between obesity and obstructive sleep apnoea (OSA), the effects of OSA and CPAP therapy on weight loss are less well known. The aim of this study in adults with class 3 obesity attending a multidisciplinary weight management program was to assess the relationship between OSA and CPAP usage, and 12-month weight change. METHODS A retrospective cohort study of all patients commencing an intensive multidisciplinary publicly funded weight management program in Sydney, Australia, between March 2018 and March 2019. OSA was diagnosed using laboratory overnight sleep studies. Demographic and clinical data, and use of CPAP therapy was collected at baseline and 12 months. CPAP use was confirmed if used ≥4 h on average per night on download. RESULTS Of the 178 patients who joined the program, 111 (62.4 %) completed 12 months in the program. At baseline, 63.1 % (n=70) of patients had OSA, of whom 54.3 % (n=38) were using CPAP. The non-OSA group had more females compared to the OSA with CPAP group and OSA without CPAP group (90.2 % vs. 57.9 % and 62.5 %, respectively; p=0.003), but there were no significant baseline differences in BMI (50.4±9.3 vs. 52.1±8.7 and 50.3±9.5 kg/m2, respectively; p=0.636). There was significant weight loss across all three groups at 12 months. However, there were no statistically significant differences across groups in the percentage of body weight loss (OSA with CPAP: 6.3±5.6 %, OSA without CPAP: 6.8±6.9 %, non-OSA: 7.2±6.5 %; p=0.844), or the proportion of patients who achieved ≥5 % body weight loss (OSA with CPAP: 57.9 %, OSA without CPAP: 59.4 %, non-OSA: 65.9 %; p=0.743). In patients with T2DM, there was a significant reduction in HbA1c from baseline to 12 months (7.8±1.7 % to 7.3±1.4 %, p=0.03), with no difference between groups (p=0.997). CONCLUSIONS This multidisciplinary weight management program resulted in significant weight loss at 12 months, regardless of OSA diagnosis or CPAP use in adults with class 3 obesity. Larger studies are needed to further investigate the effects of severity of OSA status and CPAP use in weight management programs. Until completed, this study suggests that the focus should remain on implementing lifestyle changes and weight management regardless of OSA status.
Collapse
MESH Headings
- Adult
- Aged
- Case-Control Studies
- Cholesterol/metabolism
- Continuous Positive Airway Pressure/methods
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Female
- Humans
- Hypoglycemic Agents/therapeutic use
- Lipoproteins, HDL/metabolism
- Lipoproteins, LDL/metabolism
- Male
- Middle Aged
- Obesity, Morbid/complications
- Obesity, Morbid/metabolism
- Obesity, Morbid/therapy
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/therapy
- Triglycerides/metabolism
- Weight Loss
- Weight Reduction Programs/methods
Collapse
Affiliation(s)
- Sophie Kobuch
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
| | - Fiona Tsang
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales Australia
| | - Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
| | - Daniel Gossayn
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
| | - Sarah O’Brien
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
| | - Javeria Jamal
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
| | - Leon Laks
- Australian Sleep Diagnostics, Campbelltown, New South Wales Australia
| | - Abd Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Nic Kormas
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales Australia
| | - Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, New South Wales Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales Australia
- Macarthur Clinical School, Western Sydney University, Parkside Crescent, 2560 Campbelltown, NSW Australia
| |
Collapse
|
24
|
Juhl CB, Holst R, Mundbjerg LH, Stolberg C, Gran JM, Thomsen GF. Effect of bariatric surgery on employment status-a 7 years controlled nationwide registry study. BMJ Open 2021; 11:e042845. [PMID: 34158292 PMCID: PMC8220468 DOI: 10.1136/bmjopen-2020-042845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Severe obesity is associated with a reduced ability to work. Bariatric surgery is the most effective method to achieve a sustained weight loss. Previous studies have reported conflicting results regarding the effect of bariatric surgery on employment status. To address this, we investigated the effect of bariatric surgery on employment status in the Danish population. METHODS In this nationwide study, we identified 5450 subjects who underwent bariatric surgery and 10 900 control subjects matched for age, sex and municipality. From accessible registries, we extracted data regarding employment, absenteeism, sick leave and pension. Using a multistate model, we compared time in occupational states and transitions between these states to determine the effect of bariatric surgery on employment status. FINDINGS Before surgery, cases had an absolute risk increase (95% CI)(ARI (CI)) and a relative risk (RR (CI)) of being in full-time employment of -0.12 (-0.14 to -0.10) and 0.84 (0.82 to 0.86) and were more often unemployed or in a subsidised job than the background population. Taking into account the employment status before surgery, the bariatric surgery group increased their probability of being in full-time employment 1-3 years after bariatric surgery. However, this positive effect was not present with a longer duration of follow-up. Being male, above 50 years of age, or employed as a craftsman or office worker were associated with a sustained positive effect of being in full-time employment (ARI (CI) and RR (CI) 0.05 (0.04 to 0.05) and 1.05 (1.04 to 1.06), 0.06 (0.06 to 0.07) and 1.08 (1.07 to 1.09) and 0.05 (0.05 to 0.06) and 1.05 (1.05 to 1.06), respectively). INTERPRETATION Compared with a matched control group, those undergoing bariatric surgery did not improve their employment status in the long term. Certain subgroups had a more sustained positive effect.
Collapse
Affiliation(s)
- Claus Bogh Juhl
- Department of Endocrinology, Sydvestjysk Sygehus Esbjerg, Esbjerg, Denmark
- Steno Diabetes Center, Odense University Hospital, Odense, Denmark
| | - René Holst
- Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
- Internal Medicine, Østfold Hospital, Gralum, Norway
| | | | - Charlotte Stolberg
- Department of Endocrinology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Jon Michael Gran
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Gert Frank Thomsen
- Department of Occupational Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| |
Collapse
|
25
|
Baldwin D, Sanchez-Johnsen L, Bustos R, Mangano A, Masrur M. Metabolic Surgery Outcomes in U.S. Patients with Class I Obesity. Bariatr Surg Pract Patient Care 2021; 16:85-91. [PMID: 34164238 PMCID: PMC8217597 DOI: 10.1089/bari.2020.0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Although numerous studies outside the United States (U.S.) have explored weight loss and comorbidity resolution among patients with class I obesity (body mass index [BMI] 30–34.9 kg/m2) after metabolic surgery, few U.S.-based studies have been conducted. Objective: Our aim was to compare weight loss and comorbidity resolution among U.S. patients with class I obesity, who underwent laparoscopic sleeve gastrectomy (LSG) versus Roux-en-Y gastric bypass (RYGB). Methods: Weight loss and comorbidity data among only patients with class I obesity, who underwent LSG or RYGB, were examined. Between April 2009 and April 2017, 1215 metabolic surgeries were performed with 30 patients meeting the inclusion criteria (17 LSG and 13 RYGB). Results: Percent total weight loss (%TWL) for LSG peaked at 12 months (20.85%), while RYGB %TWL peaked at 18 months (21.65%). Percent excess weight loss (%EWL) peaked at 12 months after LSG (83.59%) and 18 months after RYGB (98.29%). Overall follow-up was 56.3%, 36.7%, and 43.3% at 12, 18, and 24 months. LSG and RYGB were both successful with regard to resolution of medical comorbidities at 12 months. Conclusion: RYGB and LSG appear to have similar, successful outcomes among U.S. patients with class I obesity for weight loss and comorbidity resolution.
Collapse
Affiliation(s)
- Dustin Baldwin
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lisa Sanchez-Johnsen
- Department of Family Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Roberto Bustos
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alberto Mangano
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mario Masrur
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
26
|
Friedman AN, Kaplan LM, le Roux CW, Schauer PR. Management of Obesity in Adults with CKD. J Am Soc Nephrol 2021; 32:777-790. [PMID: 33602674 PMCID: PMC8017542 DOI: 10.1681/asn.2020101472] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Obesity is a leading public health problem that currently affects over 650 million individuals worldwide. Although interest in the adverse effects of obesity has grown exponentially in recent years, less attention has been given to studying its management in individuals with CKD. This relatively unexplored area should be considered a high priority because of the rapid growth and high prevalence of obesity in the CKD population, its broad impact on health and outcomes, and its modifiable nature. This article begins to lay the groundwork in this field by providing a comprehensive overview that critically evaluates the available evidence related to obesity and kidney disease, identifies important gaps in our knowledge base, and integrates recent insights in the pathophysiology of obesity to help provide a way forward in establishing guidelines as a basis for managing obesity in CKD. Finally, the article includes a kidney-centric algorithm for management of obesity that can be used in clinical practice.
Collapse
Affiliation(s)
- Allon N. Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lee M. Kaplan
- Obesity, Metabolism, and Nutrition Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Carel W. le Roux
- Diabetes Complications Research Center, University College Dublin, Dublin, Ireland
| | - Philip R. Schauer
- Pennington Biomedical Research Institute, Louisiana State University, Baton Rouge, Louisiana
| |
Collapse
|
27
|
Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, Barbé F, Borsini E, Caballero-Eraso C, Cano-Pumarega I, de Carlos Villafranca F, Carmona-Bernal C, Carrillo Alduenda JL, Chiner E, Cordero Guevara JA, de Manuel L, Durán-Cantolla J, Farré R, Franceschini C, Gaig C, Garcia Ramos P, García-Río F, Garmendia O, Gómez García T, González Pondal S, Hoyo Rodrigo MB, Lecube A, Madrid JA, Maniegas Lozano L, Martínez Carrasco JL, Masa JF, Masdeu Margalef MJ, Mayos Pérez M, Mirabet Lis E, Monasterio C, Navarro Soriano N, Olea de la Fuente E, Plaza G, Puertas Cuesta FJ, Rabec C, Resano P, Rigau D, Roncero A, Ruiz C, Salord N, Saltijeral A, Sampol Rubio G, Sánchez Quiroga MÁ, Sans Capdevila Ó, Teixeira C, Tinahones Madueño F, Maria Togeiro S, Troncos Acevedo MF, Vargas Ramírez LK, Winck J, Zabala Urionaguena N, Egea C. International Consensus Document on Obstructive Sleep Apnea. Arch Bronconeumol 2021; 58:52-68. [PMID: 33875282 DOI: 10.1016/j.arbres.2021.03.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents).
Collapse
Affiliation(s)
- Olga Mediano
- Unidad de Sueño, Departamento de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España; Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - Nicolás González Mangado
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Neumología, Unidad Multidisciplinar de Sueño (UMS), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, España
| | - Josep M Montserrat
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar de Patología del Sueño y VNID, Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - M Luz Alonso-Álvarez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Dr. J. Terán Santos, Departamento de Neumología, Hospital Universitario de Burgos, Burgos, España
| | - Isaac Almendros
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, España
| | - Alberto Alonso-Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Neumología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Baleares, España
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova y Santa Maria, Lleida, España
| | - Eduardo Borsini
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño y Ventilación, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Candelaria Caballero-Eraso
- Unidad de Trastornos Respiratorios del Sueño, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Irene Cano-Pumarega
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Departamento de Neumología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - Felix de Carlos Villafranca
- Servicio de Estomatología, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Asturias, España
| | - Carmen Carmona-Bernal
- Unidad de Trastornos Respiratorios del Sueño, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Jose Luis Carrillo Alduenda
- Unidad de Medicina del Sueño, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, México
| | - Eusebi Chiner
- Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, España
| | - José Aurelio Cordero Guevara
- Grupo de Investigación en Epidemiología y Salud Pública, Unidad de Metodología y Estadística, Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
| | - Luis de Manuel
- Corte del Ilustre Colegio de Abogados de Madrid, Madrid, España
| | - Joaquín Durán-Cantolla
- Servicio de Investigación, Instituto de Investigación, OSI Araba, Hospital Universitario de Araba, Vitoria-Gasteiz, Álava, España
| | - Ramón Farré
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, España
| | - Carlos Franceschini
- Unidad de Sueño y Ventilación Mecánica, Hospital Cosme Argerich, Buenos Aires, Argentina
| | - Carles Gaig
- Servicio de Neurología, Unidad Multidisciplinar de Sueño, Hospital Clínic de Barcelona, Barcelona, España
| | - Pedro Garcia Ramos
- Centro de Salud Don Benito Oeste, Servicio Extremeño de Salud, Don Benito, Badajoz, España
| | - Francisco García-Río
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Onintza Garmendia
- Unidad del Sueño, Servicio de Neumología, Hospital Clínic, Barcelona, España
| | - Teresa Gómez García
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Odontología y Unidad Multidisciplinar del Sueño del Hospital Universitario Fundación Jiménez Díaz, Sociedad Española de Medicina Dental del Sueño (SEMDeS), Madrid, España
| | - Silvia González Pondal
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Odontología y Unidad Multidisciplinar del Sueño del Hospital Universitario Fundación Jiménez Díaz, Sociedad Española de Medicina Dental del Sueño (SEMDeS), Madrid, España
| | | | - Albert Lecube
- Grupo de investigación en Obesidad, Diabetes y Metabolismo (ODIM), Servicio de Endocrinología y Nutrición, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, España
| | - Juan Antonio Madrid
- Laboratorio de Cronobiología, Universidad de Murcia, IMIB-Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, España
| | - Lourdes Maniegas Lozano
- Fundación Jiménez Díaz, Madrid, España; Neumología, Unidad Multidisciplinar de Sueño (UMS), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, España
| | | | - Juan Fernando Masa
- Hospital San Pedro de Alcántara, Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), San Pedro de Alcántara, Cáceres, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - María José Masdeu Margalef
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mercè Mayos Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Carmen Monasterio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Nieves Navarro Soriano
- Unidad de Sueño, Servicio de Neumología, Hospital Clínico Universitario, Valencia, España
| | - Erika Olea de la Fuente
- Servicio de Anestesiología y Reanimación, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, España; Hospital Universitario La Zarzuela, Madrid, España
| | - Francisco Javier Puertas Cuesta
- Unidad de Sueño, Servicio de Neurofisiología, Hospital Universitario de La Ribera, Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia, Alzira, Valencia, España
| | - Claudio Rabec
- Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, Dijon, Francia
| | - Pilar Resano
- Unidad de Sueño, Departamento de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | - Alejandra Roncero
- Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital San Pedro, Logroño, La Rioja, España
| | - Concepción Ruiz
- Servicio de Neurología, Unidad Multidisciplinar de Sueño, Hospital Clínic de Barcelona, Barcelona, España
| | - Neus Salord
- Unidad Multidisciplinar del Sueño, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Adriana Saltijeral
- Servicio de Cardiología, Hospital Universitario del Tajo, Universidad Alfonso X El Sabio, Aranjuez, Madrid, España
| | - Gabriel Sampol Rubio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - M Ángeles Sánchez Quiroga
- Hospital Virgen del Puerto, Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Plasencia, Cáceres, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Óscar Sans Capdevila
- Unidad del Sueño, Servicio de Neurología Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - Carlos Teixeira
- European Society of Sleep Technologists (EEST), Porto, Portugal
| | - Francisco Tinahones Madueño
- Sociedad Española para el Estudio de la Obesidad (SEEDO), Madrid, España; Servicio de Endocrinología, Hospital Virgen de la Victoria, (IBIMA), Centro de Investigación Biomédica en Red de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain
| | - Sônia Maria Togeiro
- Disciplina de Pneumologia, Departamento de Medicina; Disciplina de Medicina y Biologia del Sueño - Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brasil
| | | | | | - Joao Winck
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Carlos Egea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Álava, España
| | | |
Collapse
|
28
|
Clinical and Research Solutions to Manage Obstructive Sleep Apnea: A Review. SENSORS 2021; 21:s21051784. [PMID: 33806496 PMCID: PMC7961570 DOI: 10.3390/s21051784] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA), a common sleep disorder disease, affects millions of people. Without appropriate treatment, this disease can provoke several health-related risks including stroke and sudden death. A variety of treatments have been introduced to relieve OSA. The main present clinical treatments and undertaken research activities to improve the success rate of OSA were covered in this paper. Additionally, guidelines on choosing a suitable treatment based on scientific evidence and objective comparison were provided. This review paper specifically elaborated the clinically offered managements as well as the research activities to better treat OSA. We analyzed the methodology of each diagnostic and treatment method, the success rate, and the economic burden on the world. This review paper provided an evidence-based comparison of each treatment to guide patients and physicians, but there are some limitations that would affect the comparison result. Future research should consider the consistent follow-up period and a sufficient number of samples. With the development of implantable medical devices, hypoglossal nerve stimulation systems will be designed to be smart and miniature and one of the potential upcoming research topics. The transcutaneous electrical stimulation as a non-invasive potential treatment would be further investigated in a clinical setting. Meanwhile, no treatment can cure OSA due to the complicated etiology. To maximize the treatment success of OSA, a multidisciplinary and integrated management would be considered in the future.
Collapse
|
29
|
Nastałek P, Polok K, Celejewska-Wójcik N, Kania A, Sładek K, Małczak P, Major P. Impact of bariatric surgery on obstructive sleep apnea severity and continuous positive airway pressure therapy compliance-prospective observational study. Sci Rep 2021; 11:5003. [PMID: 33654165 PMCID: PMC7925607 DOI: 10.1038/s41598-021-84570-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/18/2021] [Indexed: 12/22/2022] Open
Abstract
To evaluate association between bariatric surgery and changes in obstructive sleep apnea (OSA) severity and sleep architecture was as well as to asses continuous positive airway pressure (CPAP) effectiveness and compliance. We enrolled patients undergoing bariatric surgery. Polysomnography was performed in each patient preoperatively and 12 months after the procedure in a subgroup of patients diagnosed with OSA. STOP-BANG, Epworth Sleepiness Scale (ESS) and Berlin questionnaire scores were obtained pre- and postoperatively. CPAP compliance data was recorded during follow-up hospitalization. Among 44 patients with median age of 49.5 years, predominantly women (68.2%) pre- and postoperative polysomnography was performed. We observed significant improvement in STOP-BANG (6.0 vs. 3.0, p < 0.001) and ESS (12.0 vs. 5.0, p < 0.001) scores, apnea–hypopnea index (44.9 vs. 29.2, p < 0.001), oxygen desaturation index (43.6 vs. 18.3, p < 0.001) and sleep architecture parameters. CPAP compliance was poor with a median percentage of days with CPAP use accounting to 49.3%. Bariatric surgery is associated with a significant decrease in the number of sleep-related respiratory disturbances, as well as improvement of sleep efficiency. Postoperative CPAP therapy compliance was poor despite low rate of OSA resolution. This study suggests that patients with OSA undergoing bariatric surgery require postoperative reassessment.
Collapse
Affiliation(s)
- Paweł Nastałek
- Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland.
| | - Kamil Polok
- Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Natalia Celejewska-Wójcik
- Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Aleksander Kania
- Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Krzysztof Sładek
- Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| |
Collapse
|
30
|
Jain N, Rodin J, Boon MS, Huntley CT. A systematic approach to the evaluation and management of obstructive sleep apnea: The Jefferson Protocol. Am J Otolaryngol 2021; 42:102866. [PMID: 33418179 DOI: 10.1016/j.amjoto.2020.102866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022]
Abstract
Obstructive sleep apnea (OSA) has become increasingly prevalent in the United States. While continuous positive airway pressure (CPAP) therapy remains the gold standard for treatment, surgical intervention can enhance compliance and improve outcomes for those intolerant of CPAP. Since the majority of OSA patients have multilevel obstruction, it is critical that otolaryngologists understand each patient's pattern and anatomic level of obstruction before solidifying a treatment plan. This publication serves as a comprehensive review of evaluation, characterization, and management of OSA. Further, the authors outline their departmental algorithm for identifying ideal surgical candidates and tailoring corresponding surgical interventions.
Collapse
|
31
|
Bock JM, Vungarala S, Karim S, Somers VK. Obstructive Sleep Apnea as a Cardiovascular Risk Factor-Beyond CPAP. Can J Cardiol 2021; 37:756-765. [PMID: 33610689 DOI: 10.1016/j.cjca.2021.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
Patients with obstructive sleep apnea (OSA) experience repetitive partial or complete airway collapse during sleep resulting in nocturnal hypoxia-normoxia cycling, and are at increased cardiovascular risk. The number of apneas and hypopneas indexed per hour of sleep (apnea-hypopnea index) along with the associated intermittent hypoxia predict the increased cardiovascular risk; thus, their attenuation or prevention are objectives of OSA therapy. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA and, when effective, mitigates the apnea-hypopnea index and hypoxemia. As such, it is reasonable to expect CPAP would decrease cardiovascular risk. However, 3 recent randomized clinical trials of CPAP vs usual care did not show any significant effects of CPAP in attenuating incident cardiovascular events in patients with OSA. In this review, we discuss these studies in addition to potential complementary therapeutic options to CPAP (eg, neurostimulation) and conclude with suggested therapeutic targets for future interventional studies (eg, the autonomic nervous system). Although these areas of research are exciting, they have yet to be tested to any similar degree of rigour as CPAP.
Collapse
Affiliation(s)
- Joshua M Bock
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Soumya Vungarala
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahid Karim
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
32
|
Janssens JP, Michel F, Schwarz EI, Prella M, Bloch K, Adler D, Brill AK, Geenens A, Karrer W, Ogna A, Ott S, Rüdiger J, Schoch OD, Soler M, Strobel W, Uldry C, Gex G. Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology. Respiration 2020; 99:1-36. [PMID: 33302274 DOI: 10.1159/000510086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.
Collapse
Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland,
| | - Franz Michel
- Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
| | - Esther Irene Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Maura Prella
- Division of Pulmonary Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Konrad Bloch
- Department of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Aurore Geenens
- Pulmonary League of the Canton of Vaud, Lausanne, Switzerland
| | | | - Adam Ogna
- Respiratory Medicine Service, Locarno Regional Hospital, Locarno, Switzerland
| | - Sebastien Ott
- Universitätsklinik für Pneumologie, Universitätsspital (Inselspital) und Universität, Bern, Switzerland
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Jochen Rüdiger
- Division of Pulmonary and Sleep Medicine, Medizin Stollturm, Münchenstein, Switzerland
| | - Otto D Schoch
- Division of Pulmonary Diseases, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Markus Soler
- Division of Pulmonary Diseases, St. Claraspital, Basel, Switzerland
| | - Werner Strobel
- Division of Pulmonary Diseases, Universitätsspital Basel, Basel, Switzerland
| | - Christophe Uldry
- Division of Pulmonary Diseases and Pulmonary Rehabilitation Center, Rolle Hospital, Rolle, Switzerland
| | - Grégoire Gex
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Pulmonary Diseases, Hôpital du Valais, Sion, Switzerland
| |
Collapse
|
33
|
Chen TY, Liu CT, Chung CH, Hung SL, Chien WC, Chen JH. Bariatric surgery may provide better protection than uvulopalatopharyngoplasty against major adverse cardiovascular events in obese patients with obstructive sleep apnea. Surg Obes Relat Dis 2020; 17:780-791. [PMID: 33423961 DOI: 10.1016/j.soard.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The major adverse cardiovascular events (MACE) risk is unclear among Asian obese patients with obstructive sleep apnea (OSA) who undergo bariatric surgery (BS) or uvulopalatopharyngoplasty (UPPP). OBJECTIVES We aimed to evaluate differences between Asian obese patients with OSA who underwent BS or UPPP regarding MACE. SETTING The Longitudinal Health Insurance Database, a subset of the NHI Research Database (NHIRD) originated from the National Health Insurance (NHI) program in Taiwan, which comprises information from 2 million randomly sampled individuals between 2000 and 2015. METHODS Participants aged 18-55 years whose diagnoses corresponded with codes in the International Classification of Diseases, Ninth Revision, Clinical Modification for BS, UPPP, obesity, and OSA were included in this population-based, matched cohort study of Taiwan's insurance claims data gathered between 2000 and 2015. Obese patients with OSA who underwent BS or UPPP were propensity score matched; the study's outcome was MACE. RESULTS A total of 1336 patients, comprising 668 in each of the BS and UPPP cohorts, were enrolled. After a mean follow-up period of 8.51 years, 166 patients, comprising 52 in the BS cohort and 114 in the UPPP cohort, experienced MACE. The adjusted hazard ratio (aHR) for MACE was .592 (95% confidence interval [CI] = .324-.789; P < .001). The BS cohort had lower risks of stroke (aHR = .663; 95% CI = .312-.890; P < .001), myocardial infarction (aHR = .116; 95% CI = .052-.135; P < .001), and mortality (aHR = .779; 95% CI = .423-.948; P = .001) than the UPPP cohort. CONCLUSION BS may provide greater protection against MACE than UPPP in Asian obese patients with OSA. Additional mechanistic research is needed to clarify differences between BS and UPPP in these patients.
Collapse
Affiliation(s)
- Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Sleep Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Ting Liu
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Shao-Lun Hung
- Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Jian-Han Chen
- Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan; Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
| |
Collapse
|
34
|
Donnellan E, Wazni OM, Kanj M, Baranowski B, Cremer P, Harb S, McCarthy CP, McEvoy JW, Elshazly MB, Aagaard P, Tarakji KG, Jaber WA, Schauer PR, Saliba WI. Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation. Europace 2020; 21:1476-1483. [PMID: 31304532 DOI: 10.1093/europace/euz183] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/04/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Obesity decreases arrhythmia-free survival after atrial fibrillation (AF) ablation by mechanisms that are not fully understood. We investigated the impact of pre-ablation bariatric surgery (BS) on AF recurrence after ablation. METHODS AND RESULTS In this retrospective observational cohort study, 239 consecutive morbidly obese patients (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were followed for a mean of 22 months prior to ablation. Of these patients, 51 had BS prior to ablation, and our primary outcome was whether BS was associated with a lower rate of AF recurrence during follow-up. Adjustment for confounding was performed with multivariable Cox proportional hazard models and propensity-score based analyses. During a mean follow-up of 36 months after ablation, 10/51 patients (20%) in the BS group had recurrent AF compared with 114/188 (61%) in the non-BS group (P < 0.0001). In the BS group, 6 patients (12%) underwent repeat ablation compared with 77 patients (41%) in the non-BS group, (P < 0.0001). On multivariable analysis, the association between BS and lower AF recurrence remained significant. Similarly, after weighting and adjusting for the inverse probability of the propensity score, BS was still associated with a lower hazard of AF recurrence (hazard ratio 0.14, 95% confidence interval 0.05-0.39; P = 0.002). CONCLUSION Bariatric surgery is associated with a lower AF recurrence after ablation. Morbidly obese patients should be considered for BS prior to AF ablation, though prospective multicentre studies should be performed to confirm our novel finding.
Collapse
Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Paul Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Serge Harb
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - John W McEvoy
- National University of Ireland and National Institute for Preventive Cardiology, Galway, Ireland
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Philip Aagaard
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Philip R Schauer
- Department of Bariatric Surgery, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| |
Collapse
|
35
|
Mohd Nasir AAB, Ban AYL, Syed Zakaria SZ, Nik Mahmood NRK, Abdul Hamid MF. A single tertiary centre outlook on the short-term outcome of bariatric surgery in improving pulmonary parameters and sleep apnoea. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820948533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Obesity is associated with obstructive sleep apnoea (OSA). Weight loss is an effective treatment. Bariatric surgery for obese, symptomatic OSA patients results in weight loss and improvement in lung function and sleep apnoea. This study aimed to determine the effectiveness of bariatric surgery in improving the respiratory mechanics and sleep apnoea using a lung function test and sleep study. Methods: A prospective study was conducted at the Pusat Perubatan Universiti Kebangsaan Malaysia Medical Centre involving adults undergoing bariatric work-up, attending respiratory clinic or admitted for bariatric work-up. We included subjects with a body mass index (BMI) >35 kg/m2 and Apnoea–Hypopnoea Index (AHI) of >5 events/hour. Subjects were assessed at baseline and at 12±2 weeks post bariatric surgery using the following methods: a partial sleep study, lung function test, six-minute walk test (6MWT) and Epworth Sleepiness Scale (ESS) score. Results: Twelve subjects were analysed. Their mean age was 36±5.7 years, and eight (67%) were female. The baseline mean AHI was 24.75±9.51 events/hour, the nadir mean oxygen saturation during sleep (SpO2) was 83.6±3.8%, the mean ESS score was 16±4, the mean forced expiratory volume in one second (FEV1) was 2.66±0.35 L, the mean forced vital capacity (FVC) was 3.23±0.45 L, the mean total lung capacity (TLC) was 4.97±1.19 L, the mean expiratory reserve volume (ERV) was 0.5±0.46 L, the mean residual volume (RV) was 1.46±0.91 L, the mean adjusted diffusing lung capacity for carbon monoxide (DLCO Adj) was 22.71±5.22 mL/mmHg/min, the mean adjusted diffusing lung capacity corrected for alveolar volume (DLVA Adj) was 5.61±0.90 mL/mmHg/min and the mean 6MWT was 293±49 m. Post surgery (12±2 weeks), the mean BMI decreased from 45.5 kg/m2 to 39.7 kg/m2, with a clinically significant improvement in AHI, ESS score, nadir SpO2, FEV1, FVC, TLC, ERV, RV, DLCO Adj, DLVA Adj and 6MWT ( p<0.05). Conclusion: Bariatric surgery improves sleep apnoea and lung function and reduces daytime somnolence.
Collapse
Affiliation(s)
| | - Andrea Yu-Lin Ban
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | | | | | | |
Collapse
|
36
|
Elliott AF, B C D, Stolberg CR, Hepp N, Juhl AJA, Adhikari K, Juhl CB. Attitudes and knowledge regarding referrals for bariatric surgery among Danish secondary healthcare providers: A national survey. Clin Obes 2020; 10:e12369. [PMID: 32458582 DOI: 10.1111/cob.12369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022]
Abstract
Bariatric surgery induces significant and sustained weight loss and subsequently reduces obesity-related comorbidities. However, only a small percentage of patients with severe obesity undergo bariatric surgery in Denmark. There is limited knowledge about the experiences with and possible reservations to bariatric surgery among secondary healthcare providers. The aim of this cross-sectional study was to investigate referral patterns and knowledge regarding the criteria for bariatric surgery among Danish secondary healthcare providers, treating obesity-related diseases. A questionnaire regarding experiences with and reservations to referring patients for consideration for bariatric surgery, along with thoughts to specific patient cases were sent to several specialists: endocrinologists, obstetricians and gynaecologists, orthopaedic surgeons and otorhinolaryngologists. Most questions required responses on a 5-point Likert scale and frequency distributions were calculated. A total of 345 (44%) specialists responded to the questionnaires. Good knowledge of the criteria for referral to bariatric surgery varied among the specialist from 6% to 68%. One of the main issues was a concern about the medical and surgical postoperative complications, which was a barrier to and influenced referral decisions. Furthermore, specialists were more likely to refer patients to bariatric surgery when patients requested this. Except for endocrinologists, the Danish secondary healthcare specialists interviewed have limited knowledge about bariatric surgery, which results in a reluctance in referring patients. Our results indicate that there is a need to improve knowledge among specialists, regarding the indications, criteria and outcomes for bariatric surgery to establish a more pro-active, specialist led approach to referrals.
Collapse
Affiliation(s)
- Anja F Elliott
- Department of Medicine, Section of Endocrinology, Southwest Jutland Hospital, Esbjerg, Denmark
| | - Deepti B C
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte R Stolberg
- Department of Medicine, Section of Endocrinology, Southwest Jutland Hospital, Esbjerg, Denmark
| | - Nicola Hepp
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anna J A Juhl
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kalyan Adhikari
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus B Juhl
- Department of Medicine, Section of Endocrinology, Southwest Jutland Hospital, Esbjerg, Denmark
| |
Collapse
|
37
|
Correlation between Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Disease before and after Metabolic Bariatric Surgery. Obes Surg 2020; 30:3803-3812. [PMID: 32529354 DOI: 10.1007/s11695-020-04696-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Emerging evidence has revealed that obstructive sleep apnea (OSA) is associated with non-alcoholic fatty liver disease (NAFLD). However, the impact of OSA on NAFLD among obese patients undergoing metabolic and bariatric surgery (MBS), especially during follow-up period, remains unclear. OBJECTIVE To analyze the correlation based on preoperative characteristics and postoperative conditions among bariatric patients with comorbid OSA and NAFLD. METHODS Clinical data of patients who underwent MBS in our institution between January 2016 and June 2019 were reviewed retrospectively. Correlation analysis and linear regressions were used to identify how OSA links with NAFLD before and after treatment of MBS. RESULTS Of 308 patients, 181 were diagnosed with OSA and enrolled in the present study, and 127 completed follow-up visits at 6 months. The proportion of NAFLD in the mild-moderate OSA and severe OSA groups was 75.0% and 96.0%, respectively. MBS was effective at improving sleep apnea and nocturnal hypoxia, as well as liver steatosis and fibrosis (P < 0.05). And we also found that there were significant correlations not only between OSA- and NAFLD-related characteristics at baseline but also between their improvements after surgery, eventually leading to similar prognosis of NAFLD for both groups (P < 0.05), no matter what presurgical differences existed. In addition, the results of the univariate and multivariate linear regression analyses supported preoperative liver/spleen Hounsfield units ratio (LSR) by computerized tomography (CT) as an independent predictor of the effect of MBS on liver steatosis. CONCLUSION In conclusion, MBS plays a pivotal role in the control of medical conditions in obese patients with OSA and NAFLD. Given the correlation between OSA and NAFLD in the present study, in the case of both the severity at baseline as well as the improvement after surgery, OSA may pose an impact on the prognosis of NAFLD in bariatric patients.
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW Through its direct adverse effects on the kidney and via associated intermediate disease states like type 2 diabetes and hypertension, obese has arguably become the master risk factor for chronic kidney disease (CKD). The purpose of this review is to critically evaluate bariatric surgery, which is the most effective weight reduction strategy available, as a renoprotective strategy. RECENT FINDINGS Recent randomized studies confirm that bariatric surgery is effective at improving or even remitting major CKD risk factors such as type 2 diabetes and hypertension. In addition, observational studies performed primarily in patients without preexisting CKD report improvements in estimated glomerular filtration rate and albuminuria after bariatric surgery. Yet this literature is limited by study design, participant selection, statistical power, and measurement issues that must be overcome to better define kidney-related benefits, especially with regard to harder kidney-related and other clinical endpoints. SUMMARY Encouraging data exist on the renoprotective effects of bariatric surgery. However, important knowledge gaps still remain. Future research should focus on studying, ideally in randomized fashion, the renoprotective effects of bariatric surgery in patients with preexisting CKD to better define the benefit-risk ratio for each patient.
Collapse
Affiliation(s)
- Allon N Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ricardo V Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| |
Collapse
|
39
|
Abstract
Obstructive sleep apnea (OSA) is a multisystem breathing disorder associated with increased morbidity and mortality. Clinical and operative assessment tools improve surgical approaches to treat airway obstruction. The primary sites of anatomic obstruction are at the levels of the nasal, palatal, and hypopharyngeal airway. The literature suggests a relationship between reduced neuromuscular tone and the age-related increase in OSA prevalence for normal-weight adults. Pharyngeal soft tissue collapse due to reduced airway pressure is defined as the critical closing pressure. Respiratory biochemistry homeostasis is an additional factor in maintaining airway patency.
Collapse
Affiliation(s)
- Kevin Coughlin
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 410, Memphis, TN 38163, USA
| | - George M Davies
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 327, Memphis, TN 38163, USA.
| | - Marion Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 408, Memphis, TN 38163, USA
| |
Collapse
|
40
|
Salman LA, Shulman R, Cohen JB. Obstructive Sleep Apnea, Hypertension, and Cardiovascular Risk: Epidemiology, Pathophysiology, and Management. Curr Cardiol Rep 2020; 22:6. [PMID: 31955254 DOI: 10.1007/s11886-020-1257-y] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Given the rising prevalence of obstructive sleep apnea (OSA), we aimed to review the epidemiologic and pathophysiologic relationship of OSA, hypertension, and cardiovascular disease, and to summarize recent advances in the treatment of OSA. RECENT FINDINGS OSA is associated with an elevated risk of hypertension and cardiovascular disease. Several pathophysiologic factors contribute to the relationship between OSA and vascular risk, including neurohormonal dysregulation, endothelial dysfunction, and inflammation. While CPAP reduces blood pressure, it has not been demonstrated to reduce cardiovascular risk. The combination of CPAP and weight loss has a synergistic effect on blood pressure and several metabolic parameters. Adherence to CPAP is poor across studies, potentially contributing to the attenuation of perceived cardiovascular benefit from CPAP therapy. A greater emphasis on adherence to CPAP and the combination of CPAP and weight loss are central to reducing cardiovascular risk among individuals with OSA.
Collapse
Affiliation(s)
- Liann Abu Salman
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - Rachel Shulman
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 831 Blockley, Philadelphia, PA, 19104, USA.
| |
Collapse
|
41
|
Zhang Y, Wang W, Yang C, Shen J, Shi M, Wang B. Improvement in Nocturnal Hypoxemia in Obese Patients with Obstructive Sleep Apnea after Bariatric Surgery: a Meta-Analysis. Obes Surg 2019; 29:601-608. [PMID: 30411226 DOI: 10.1007/s11695-018-3573-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To conduct a meta-analysis examining the effects of bariatric surgery on nocturnal hypoxemia in obese patients with obstructive sleep apnea (OSA). METHODS PubMed, EMBASE, Cochrane Library, and Web of Science were searched (the last search date was June 10, 2018) to identify relevant clinical studies. The mean arterial oxygen saturation (MeanSaO2), nadir oxygen saturation (NadirSaO2), apnea hypopnea index (AHI), and body mass index (BMI) data during the perioperative period were extracted and analyzed using a random effects model. Then, we performed subgroup and sensitivity analyses and calculated the publication bias to assess the between-study heterogeneity. RESULTS In total, 15 studies with 636 patients were included; 13 were prospective observational trials, 1 was a randomized controlled trial (RCT), and 1 was a retrospective trial. After surgery, the MeanSaO2 and NadirSaO2 increased by 1.36 [95% CI (0.72, 2.00)] and 1.08 [95% CI (0.68, 1.49)], respectively, and the AHI and BMI decreased by 1.11 [95% CI (0.82, 1.40)] and 1.97 [95% CI (1.67, 2.27)], respectively. However, the heterogeneity across all trials was high; we identified some of the sources of that heterogeneity through subsequent subgroup and sensitivity analyses. CONCLUSIONS Bariatric surgery is effective at improving nocturnal hypoxemia in obese patients with OSA; it also reduces body weight and the number of apnea events. More randomized controlled and comparative trials are necessary in the future to confirm our findings and to explore the potential underlying mechanisms.
Collapse
Affiliation(s)
- Yuxiang Zhang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China
| | - Wenyue Wang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China
| | - Chengcan Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China
| | - Jiahui Shen
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China
| | - Meilong Shi
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China
| | - Bing Wang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China.
| |
Collapse
|
42
|
|
43
|
Donnellan E, Wazni O, Kanj M, Hussein A, Baranowski B, Lindsay B, Aminian A, Jaber W, Schauer P, Saliba W. Outcomes of Atrial Fibrillation Ablation in Morbidly Obese Patients Following Bariatric Surgery Compared With a Nonobese Cohort. Circ Arrhythm Electrophysiol 2019; 12:e007598. [DOI: 10.1161/circep.119.007598] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Morbid obesity is associated with unacceptable high recurrence rates following atrial fibrillation ablation. The role of risk-factor modification including weight loss and improved glycemic control in reducing arrhythmia recurrence following ablation has been highlighted in recent years. In this study, we compared arrhythmia recurrence rates in morbidly obese patients who underwent prior bariatric surgery (BS) with those of nonobese patients following atrial fibrillation ablation in addition to morbidly obese patients who did not undergo BS.
Methods:
This was a single-center observational cohort study. We matched 51 morbidly obese patients [body mass index ≥40 kg/m
2
] who had undergone prior BS in a 2:1 manner with 102 nonobese patients and 102 morbidly obese patients without prior BS on the basis of age, sex, and timing of atrial fibrillation ablation. Our primary outcome of interest was arrhythmia recurrence.
Results:
From the time of BS to ablation, BS was associated with a significant reduction in body mass index (47.6±9.3 to 36.7±7;
P
<0.0001), glycated hemoglobin (6.7±1.5 to 5.8±0.6;
P
<0.0001), and systolic blood pressure (145±13 to 118±11;
P
<0.0001). During a mean follow-up of 29±13 months following ablation, recurrent arrhythmia occurred in 10/51 (20%) patients in the BS group compared with 25/102 (24.5%) patients in the nonobese group and 56 (55%) patients in the non-BS morbidly obese group (
P
<0.0001). No procedural complications were observed in the BS group.
Conclusions:
Bariatric surgery is associated with a reduction in arrhythmia recurrence following atrial fibrillation ablation in morbidly obese patients to those of nonobese patients. Morbidly obese patients should be considered for BS before atrial fibrillation ablation.
Collapse
Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | - Bruce Lindsay
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Ali Aminian
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Wael Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Philip Schauer
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Walid Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| |
Collapse
|
44
|
Affiliation(s)
- Sigrid C Veasey
- From the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ilene M Rosen
- From the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
45
|
Tham KW, Lee PC, Lim CH. Weight Management in Obstructive Sleep Apnea: Medical and Surgical Options. Sleep Med Clin 2019; 14:143-153. [PMID: 30709529 DOI: 10.1016/j.jsmc.2018.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Obesity plays a pivotal role in the pathogenesis of obstructive sleep apnea (OSA) and as an exacerbating factor of OSA. Given the interlinking relationship of obesity and OSA, treatment of obesity is fundamental in the management of OSA. Weight loss of 7% to 11% significantly improves OSA with remission seen with greater weight loss. Weight loss also ameliorates the constellation of other obesity-related metabolic conditions, reducing the overall cardiovascular risk in an obese person with OSA. This article discusses specific weight loss interventions effective in improving OSA, including lifestyle interventions with dietary modification and physical activity, pharmacotherapy, and bariatric surgery.
Collapse
Affiliation(s)
- Kwang Wei Tham
- The Academia, 20 College Road, Singapore 169856, Singapore.
| | | | - Chin Hong Lim
- The Academia, 20 College Road, Singapore 169856, Singapore
| |
Collapse
|
46
|
Glazer SA, Erickson AL, Crosby RD, Kieda J, Zawisza A, Deitel M. Response to Dr. Friel's Letter to the Editor. Obes Surg 2019; 29:1373-1374. [PMID: 30712170 DOI: 10.1007/s11695-019-03739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stephen A Glazer
- Internal Medicine, Medical Director Bariatric Program, Humber River Hospital, 200 Ronson Drive Suite 104, Etobicoke, Toronto, Ontario, M9W 5Z9, Canada.
| | | | - Ross D Crosby
- Department of Biomedical Statistics, Neuropsychiatric Research Institute, Fargo, ND, USA
| | | | | | | |
Collapse
|
47
|
Acker JG, Cordi MJ. [Sleep Disturbances in General Practitioners' Offices: From Screening to Initial Therapy - Update 2019]. PRAXIS 2019; 108:103-109. [PMID: 30722730 DOI: 10.1024/1661-8157/a003166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sleep Disturbances in General Practitioners' Offices: From Screening to Initial Therapy - Update 2019 Abstract. The field of sleep medicine has established internationally as an interdisciplinary specialization. Due to prevailing evidence, sleep disturbances are listed in a separate chapter in the new ICD 11 classification system. With the International Classification of Sleep Disorders (ICSD-3rd version) a standalone classification system exists. In Switzerland, one third of the population suffers from sleep disturbances. Even differential diagnosis is hard to establish. The current article aims at practitioners, who are frequently confronted with sleep complaints and must categorize, triage and initially treat their patients with simple screening methods.
Collapse
|
48
|
Friel M. Letter to the Editor: Regarding The Evaluation of Screening Questionnaires for Obstructive Sleep Apnea to Identify High-Risk Obese Patients Undergoing Bariatric Surgery. Obes Surg 2018; 29:299-300. [PMID: 30370483 DOI: 10.1007/s11695-018-3547-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mark Friel
- Griffith University, Nathan, Australia. .,University of Queensland, St Lucia, Australia. .,Queen Elizabeth II Hospital, Troughton Rd & Kessels Rd, Coopers Plains, QLD, 4108, Australia.
| |
Collapse
|
49
|
Xanthopoulos MS, Berkowitz RI, Tapia IE. Effects of obesity therapies on sleep disorders. Metabolism 2018; 84:109-117. [PMID: 29409812 DOI: 10.1016/j.metabol.2018.01.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/18/2018] [Accepted: 01/26/2018] [Indexed: 12/21/2022]
Abstract
Obesity is a significant risk factor for obstructive sleep apnea syndrome (OSAS), and has also been linked to reductions in sleep quality and quantity. Weight loss has been shown to be an effective treatment for improving OSAS; however, there is a high degree of variability in improvements of OSAS in response to weight loss. There are three modalities of obesity therapies: 1) lifestyle modification, which includes changes in dietary intake and physical activity, along with behavioral interventions; 2) pharmacologic agents; and 3) bariatric surgery. Individuals have a highly variable response to the various obesity interventions, and maintenance of weight loss can be especially challenging. These factors influence the effect of weight loss on sleep disorders. There is still a need for large, well-controlled studies examining short- and long-term efficacy of weight loss modalities and their impact on long-term treatment of OSAS and other sleep parameters, particularly in youth. Nonetheless, given our current knowledge, weight reduction should always be encouraged for people coping with obesity, OSAS, and/or sleep disruptions and resources identified to assist patients in choosing a weight loss approach that will benefit them the most.
Collapse
Affiliation(s)
- Melissa S Xanthopoulos
- Sleep Center in the Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Robert I Berkowitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ignacio E Tapia
- Sleep Center in the Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
50
|
Carneiro G, Zanella MT. Obesity metabolic and hormonal disorders associated with obstructive sleep apnea and their impact on the risk of cardiovascular events. Metabolism 2018. [PMID: 29534971 DOI: 10.1016/j.metabol.2018.03.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyze metabolic and hormonal disorders resulting from the association between obesity and obstructive sleep apnea (OSA) syndrome that predispose to cardiovascular diseases and investigate the clinical benefits obtained from treatment approaches for both conditions. METHODS A literature review between 1997 and 2017 was conducted in the PubMed search database. RESULTS Obesity is the most important risk factor for OSA, and the progressive increase in its prevalence also affects OSA incidence. In addition, OSA may aggravate weight gain and obesity comorbidities. Both conditions lead to an increase in the risk of cardiovascular events and mortality. The gold standard treatment for moderate to severe OSA is CPAP, but significant reduction in major cardiovascular events was not observed in clinical trials. Body weight reduction appears effective to improve OSA, as long as it is maintained. Lifestyle modifications and drug therapy seem to be the preferred approach to treat obesity, but in severe obesity and moderate to severe OSA, bariatric surgery is probably the most adequate treatment. CONCLUSIONS Weight control is essential to decrease the risk of cardiovascular events and mortality potentially linked to both obesity and OSA. CPAP seems to treat only OSA without decreasing these risks. Other treatment strategies are lifestyle modifications and drug therapy, which need further investigation as well as bariatric surgery for severe cases.
Collapse
Affiliation(s)
- Glaucia Carneiro
- Disciplina de Endocrinologia, Departamento de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
| | - Maria T Zanella
- Disciplina de Endocrinologia, Departamento de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|