1
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Geng C, Chen C. Estimating the prevalence and clinical causality of obstructive sleep apnea in paediatric narcolepsy patients. Sleep Breath 2024:10.1007/s11325-024-03100-6. [PMID: 38985234 DOI: 10.1007/s11325-024-03100-6] [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: 02/26/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Numerous risk factors in paediatric narcolepsy may predispose them to obstructive sleep apnea (OSA). The concurrent presence of OSA in these patients might lead to underdiagnosing narcolepsy. This research investigates the prevalence and potential causality between OSA and paediatric narcolepsy. METHODS A case-control study coupled with a two-sample Mendelian randomization (MR) analysis was employed to explore the prevalence and causal link between paediatric narcolepsy and OSA risk. RESULTS The case-control study revealed that paediatric narcolepsy patients are at an increased risk of OSA, with an Odds ratio (OR) of 4.87 (95% CI: 2.20-10.71; P < 0.001). The inverse-variance weighted (IVW) model further suggests a potential causal link between narcolepsy and OSA (IVW OR: 4.671, 95% CI: 1.925-11.290; P < 0.001). Additionally, sensitivity analysis confirmed these findings' reliability. CONCLUSION The findings highlight an elevated prevalence and genetic susceptibility to OSA among paediatric narcolepsy patients, underscoring the necessity for clinical screening of OSA. Continued research is essential to clarify the pathogenic mechanisms and develop potential treatments.
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Affiliation(s)
- Chaofan Geng
- Department of Neurology & Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing, China
| | - Chen Chen
- Department of Neurology & Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing, China.
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, 7 Weiwu Street, Zhengzhou, 450000, China.
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2
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Beck RH, Afrooz I, Suhail Masalawala M, Watad R, Al Shaban T, Deeb A. Characteristics of adolescents referred for bariatric surgery in Abu Dhabi, United Arab Emirates. Front Pediatr 2024; 12:1297251. [PMID: 38523841 PMCID: PMC10957758 DOI: 10.3389/fped.2024.1297251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
About a third of children and adolescents are overweight or obese in the United Arab Emirates, and referrals for metabolic and bariatric surgery (MBS) are now common. Despite excellent evidence that MBS should be considered in adolescents with severe obesity, it remains a management approach of last resort in many cases. Baseline, real-world data on adolescent patients living with obesity referred for surgery, their characteristics, and how these relate to current and future referral policy are important to ensure best practice. Here we examined the demographic, anthropometric, and clinical characteristics of adolescents referred for MBS over a three-year period to Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE. Ninety-two adolescents living with obesity were recruited: 54.3% were female, the average age was 16.3 ± 2.4 years, and 88.0% of patients had a first-degree relative with a history of obesity and 62% a family history of bariatric surgery. The average BMI was 47.7 ± 10.5, and the average percentage of the 95th percentile BMI was 169.5 ± 38.8%. Complications of obesity (hypertension, type 2 diabetes and prediabetes, dyslipidemia, and liver function abnormalities) were common. Our analysis highlights that there exists a mismatch between the profiles of patients referred for MBS, local guidelines, and international best practice in decision-making for referral to MBS services. While many adolescents in the UAE seem to enjoy family support and experience in the surgical management of obesity, local guidelines need updating to reflect changes in the definitions of obesity, thresholds for referral, and to remove unnecessary developmental stage barriers to increase the window for personalized surgical management.
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Affiliation(s)
- Reem Hassan Beck
- Clinical Trial Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Imrana Afrooz
- Clinical Trial Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Rama Watad
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Talat Al Shaban
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Asma Deeb
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
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3
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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.
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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
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Wyszomirski K, Walędziak M, Różańska-Walędziak A. Obesity, Bariatric Surgery and Obstructive Sleep Apnea-A Narrative Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1266. [PMID: 37512076 PMCID: PMC10385107 DOI: 10.3390/medicina59071266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
The purpose of this review was to analyze the available literature on the subject of obesity and obstructive sleep apnea. We searched for available articles for the time period from 2013 to 2023. Obesity is listed as one of the most important health issues. Complications of obesity, with obstructive sleep apnea (OSA) listed among them, are common problems in clinical practice. Obesity is a well-recognized risk factor for OSA, but OSA itself may contribute to worsening obesity. Bariatric surgery is a treatment of choice for severely obese patients, especially with present complications, and remains the only causative treatment for patients with OSA. Though improvement in OSA control in patients after bariatric surgery is well-established knowledge, the complete resolution of OSA is achieved in less than half of them. The determination of subpopulations of patients in whom bariatric surgery would be especially advantageous is an important issue of OSA management. Increasing the potential of non-invasive strategies in obesity treatment requires studies that assess the efficacy and safety of combined methods.
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Affiliation(s)
- Krzysztof Wyszomirski
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine-National Research Institute, Szaserów 128 St., 04-141 Warsaw, Poland
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
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5
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Salman MA, Abelsalam A, Nashed GA, Yacoub M, Abdalla A. Long Biliopancreatic Limb Roux-En-Y Gastric Bypass Versus One-Anastomosis Gastric Bypass: a Randomized Controlled Study. Obes Surg 2023; 33:1966-1973. [PMID: 37178225 PMCID: PMC10289940 DOI: 10.1007/s11695-023-06631-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. The one-anastomosis gastric bypass (OAGB) procedure, first introduced by Dr. Rutledge, has demonstrated a 25% greater weight loss efficiency than the traditional Roux-en-Y gastric bypass (RYGB) procedure due to the substantially longer biliopancreatic limb (BPL). AIM OF THE STUDY The current work aimed to compare the outcomes of OAGB and long BPL RYGB regarding weight loss and comorbidity resolution. PATIENTS AND METHODS This randomized controlled trial was done at our institution between September 2019 and January 2021. Patients who were candidates for bariatric surgery were randomly and equally allocated to two groups. Group A underwent OAGB, while group B underwent long BPL RYGB. Patients were followed up for 6 months postoperatively. RESULTS This study included 62 patients equally allocated to OAGB or long BPL RYGB, with no dropouts during follow-up. At 6 months, there was no statistically significant difference between the two groups regarding postoperative BMI (P = 0.313) and the EBWL (P = 0.238). There was comparable remission of diabetes mellitus (P = 0.708), hypertension (P = 0.999), OSA (P = 0.999), joint pain (P = 0.999), and low back pain (P = 0.999). Seven patients in the OAGB group experienced reflux symptoms (P = 0.011), which were managed by proton pump inhibitors. CONCLUSION Extending the BPL in RYGB provides weight loss and comorbidity remission comparable to that of OAGB. Some OAGB-related reflux cases remain a concern. However, they were sufficiently controlled with PPIs. Due to OAGB superior technical simplicity, long BPL RYGB should be preserved for cases whom are more risky for bile reflux.
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Al-Mohaidly MT, Al-Asmari AK, Khan HA, Alshngeetee AS, Khan I, Al-Asmari YA, Al-Hussain GO, Alsalem SS, Khan A, Babtain AM, Aljorfi EA, Alshumiesy HA, Aluraifej MA. Laparoscopic sleeve gastrectomy for obesity treatment in adolescents and young adults: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:158. [PMID: 37093297 DOI: 10.1007/s00423-023-02894-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The incidence of obesity has been increasing in younger population, posing a significant impact on adolescents' life and health care system worldwide. METHODS We critically analyzed the existing literature on the use of laparoscopic sleeve gastrectomy (LSG) for the treatment of obesity. We performed an in-depth evaluation of 37 studies and analyzed the effect of LSG in 2300 patients, aged ≤ 22 years. RESULTS Mean body mass index (BMI) loss after LSG was 17.81 kg/m2. Gastroesophageal reflux was the most common complication. Most of the patients showed remission of comorbidities including hypertension, diabetes, and obstructive sleep apnea after LSG. CONCLUSIONS These findings suggest that surgical intervention is highly beneficial for reducing BMI in appropriately selected adolescents and young adults suffering from obesity and comorbidities such as life-threatening obstructive sleep apnea.
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Affiliation(s)
- Mohammed T Al-Mohaidly
- Department of Pediatric Surgery, Prince Sultan Military Medical City, Riyadh, 11159, Saudi Arabia.
| | - Abdulrahman K Al-Asmari
- Scientific Research Center, Medical Service Department (MSD), Ministry of Defence, Riyadh, Saudi Arabia
| | - Haseeb A Khan
- Department of Biochemistry, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Ayshah S Alshngeetee
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Isra Khan
- Rohilkhand Medical College and Hospital, Bareilly, 243006, India
| | - Yaser A Al-Asmari
- Shaqra General Hospital, Ministry of Health (MOH), Shaqra, 15562, Saudi Arabia
| | - Ghadah O Al-Hussain
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Sarah S Alsalem
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Ayaat Khan
- Intigeral Institute of Medical Sciences and Research, Lucknow, 226026, India
| | - Aishah M Babtain
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Ebtihaj A Aljorfi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Hend A Alshumiesy
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Mashael A Aluraifej
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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7
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Sithirungson S, Sonsuwan N, Chattipakorn SC, Chattipakorn N, Shinlapawittayatorn K. Functional roles of orexin in obstructive sleep apnea: From clinical observation to mechanistic insights. Sleep Med 2023; 101:40-49. [PMID: 36334500 DOI: 10.1016/j.sleep.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/23/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Obstructive sleep apnea is the most common sleep-related breathing disorder. Repetitive episodes of the obstructive respiratory events lead to arousal, sleep fragmentation, and excessive daytime sleepiness. Orexin, also known as hypocretin, is one of the most important neurotransmitters responsible for sleep and arousal regulation. Deficiency of orexin has been shown to be involved in the pathogenesis of narcolepsy, which shares cardinal symptoms of sleep apnea and excessive daytime sleep with obstructive sleep apnea. However, the relationship between orexin and obstructive sleep apnea is not well defined. In this review, we summarize the current evidence, from in vitro, in vivo, and clinical data, regarding the association between orexin and obstructive sleep apnea. The effects of orexin on sleep apnea, as well as how the consequences of obstructive sleep apnea affect the orexin system function are also discussed. Additionally, the contrary findings are also included and discussed.
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Affiliation(s)
- Suchanya Sithirungson
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nuntigar Sonsuwan
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Krekwit Shinlapawittayatorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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8
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He Y, Zhou LQ, Hu Y, Cheng Q, Niu X. Serum leptin differs in children with obstructive sleep apnea: A meta-analysis and PRISMA compliant article. Medicine (Baltimore) 2022; 101:e30986. [PMID: 36254000 PMCID: PMC9575813 DOI: 10.1097/md.0000000000030986] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) as an independent cardiovascular risk factor has been proposed, but the mechanisms underlying cardiovascular disease is far from being completely elucidated. Leptin, an inflammatory cytokine produced by adipocytes, contributes to the modulation of metabolism, respiratory control, and inflammation, which are factors associated with cardiovascular disease. Serum levels of leptin in children with OSA have shown conflicting results in previous studies. METHODS We performed a meta-analysis to clarify the correlation between leptin expression of the OSA patients following the PRISMA. PubMed, Embase, and Web of Science were systematically searched for relevant studies, and then independently screened by two researchers, and analyzed the data through STATA version 12.0. RESULTS In a total of 5 articles including 469 participants, the data analysis showed that serum leptin levels were elevated in children with OSA (MD, 6.36; 95% CI, 0.24-12.49, P < .001), compared to the control group. Subgroup analysis were performed based on body mass index. The results of subgroup analysis demonstrated that the serum leptin concentration was correlated with body mass index in children with OSA (MD, 9.70; 95% CI, 0.22-11.18, P < .001). CONCLUSIONS The serum leptin levels were elevated in children with OSA, compared to the control group. It could add to our developing understanding of the pathogenesis and potential treatments for children with OSA, and help us to recognize the relevance of OSA in determining cardiovascular issues among children.
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Affiliation(s)
- Yao He
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liu-Qing Zhou
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao Hu
- Department of Otorhinolaryngology, The Central Hospital of Wuhan, Wuhan, China
| | - Qing Cheng
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * Correspondence: Qing Cheng, Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (e-mail: ) and Xun Niu, Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (e-mail: )
| | - Xun Niu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * Correspondence: Qing Cheng, Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (e-mail: ) and Xun Niu, Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (e-mail: )
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Biochemical Markers and Obstructive Sleep Apnea Risk in Individuals After Long-Term Bariatric Surgery. Obes Surg 2022; 32:3272-3279. [PMID: 35915315 DOI: 10.1007/s11695-022-06222-6] [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: 12/15/2021] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Individuals who have undergone long-term bariatric surgery may be at increased obstructive sleep apnea (OSA) risk. The purpose of this study was to estimate the frequency of OSA risk and its associations, via biochemical markers, in patients who have undergone long-term bariatric surgery. METHODS This cross-sectional study evaluated patients after 5 years or more post Roux-en-Y gastric bypass. Biochemical markers, anthropometrics, and OSA risk, via the STOP-Bang score screening tool, were evaluated. Independent Student t, Pearson's chi-squared, or correlation tests were applied, according to total OSA risk score groups or its isolated components. RESULTS Among the 77 patients evaluated (88.3% female; body mass index = 32.7 ± 5.8 kg/ m2; postoperative time = 9.9 ± 3.1 years), 36 were at risk for OSA. OSA risk score was positively correlated to high-sensitivity C-reactive protein levels (r2 = 0.270; p = 0.025), triglycerides (r2 = 0.338, p = 0.004), total cholesterol (r2 = 0,262; p = 0,028), and HbA1c (r2 = 0.332; p = 0.005). Compared to each counterpart, basal insulin and triglycerides were higher among those who self-reported witnessed apnea (12.8 ± 6.5 vs 8.1 ± 3.8, p = 0.013; 136.4 ± 41.1 vs 88.5 ± 34.8, p = 0.001, respectively), while levels of total cholesterol and LDL-C were higher in participants who reported tiredness (183.9 ± 27.0 vs 164.8 ± 33.4, p = 0.005; 105.9 ± 24.4 vs 92.0 ± 26.6, p = 0.018). Participants with snoring also had higher levels of triglycerides (107 ± 41.1 vs 83.7 ± 33.9, p = 0.010). CONCLUSIONS OSA risk was highly prevalent among patients who had undergone long-term bariatric surgery, as noted via increased STOP-Bang scores, as were isolated components related to inflammatory markers and lipid and glycemic profile.
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10
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Afolabi-Brown O, Moore ME, Tapia IE. Sleep Deficiency in Adolescents: The School Start Time Debate. Clin Chest Med 2022; 43:239-247. [PMID: 35659022 DOI: 10.1016/j.ccm.2022.02.008] [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] [Indexed: 11/19/2022]
Abstract
Adolescence is commonly accepted as a challenging time for sleep, with multiple factors contributing to sleep deficiency in adolescents. These include physiologic changes with shifts in their circadian rhythm; medical sleep disorders; and social, cultural, and environmental factors. Early school start times negatively affect sleep in adolescents as well, with poorer outcomes in their overall health, wellbeing, and performance. This article highlights the different contributing factors for sleep deficiency in adolescents and the consequences of sleep deficiency. In addition, the authors discuss the impact of delayed school start times in improving adolescents' sleep and overall function.
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Affiliation(s)
- Olufunke Afolabi-Brown
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Melisa E Moore
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Children and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ignacio E Tapia
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Thaher O, Tallak W, Hukauf M, Stroh C. Outcome of Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass for Patients with Super Obesity (Body Mass Index > 50 kg/m 2). Obes Surg 2022; 32:1546-1555. [PMID: 35175541 DOI: 10.1007/s11695-022-05965-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE With increasing BMI, the complexity of treating patients with obesity rises. The focus of this study is to investigate the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on perioperative morbidity and remission of comorbidities at 3 years in patients with a BMI > 50 kg/m2. MATERIALS AND METHODS A retrospective multicenter analysis of a prospectively maintained database was performed to enroll patients with a 3-year follow-up after SG or RYGB between 2005 and 2019 and a BMI of > 50 kg/m2 preoperatively. Patients' BMI and comorbidity status were recorded preoperatively. RESULTS We analyzed data from 2939 patients who had at least a preoperative BMI > 50 kg/m2. A total of 1278 patients underwent RYGB surgery, and 1661 underwent SG. The distribution of sex, BMI, hypertension, reflux, and sleep apnea was significant between the two groups. Three years after surgery, the percent excess weight loss (%EWL) was 62.21% in RYGB and 55.87% in SG (p < 0.001). The change in hypertension (p < 0.001) and reflux (p < 0.001) was significantly in favor of RYGB. The change in diabetes mellitus was not significant between the two groups (p > 5%). There was a minimal difference in sleep apnea in favor of SG (p < 0.001). Mortality and overall complication rates were not significant in either group. CONCLUSION Both procedures positively affected comorbidities, BMI, and %EWL in patients with super obesity 3 years after surgery. In some categories, RYGB was better than SG. Nevertheless, the decision between the two methods remains a matter of the surgeon's experience and the patient's general condition.
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Affiliation(s)
- Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Wael Tallak
- Department of Neurosurgery, Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany
| | - Martin Hukauf
- StatConsult Society for Clinical and Health Services Research mbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - Christine Stroh
- Department of Obesity and Metabolic Surgery, SRH Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany.
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12
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Update and Progress in Pediatric Sleep Disorders. J Pediatr 2021; 239:16-23. [PMID: 34450124 DOI: 10.1016/j.jpeds.2021.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 08/01/2021] [Accepted: 08/18/2021] [Indexed: 12/28/2022]
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13
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[Diagnostic criteria for obstructive sleep apnea syndrome in adolescent]. Rev Mal Respir 2021; 38:829-839. [PMID: 34565640 DOI: 10.1016/j.rmr.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/13/2021] [Indexed: 11/20/2022]
Abstract
The obstructive sleep apnoea syndrome (OSAS) affects 1-4% of adolescents. It represents a transitional stage between paediatric and adult OSA and is characterized by specific symptoms. BACKGROUND: The persistence of childhood OSAS during adolescence is not frequent. Risk factors are male sex, obesity and a history of tonsillectomy or adenoidectomy. Symptoms may be misleading such as tiredness and depressive disorders. In adolescence, untreated OSAS may result in neuro-behavioural and cognitive deficits, systemic inflammation, cardiovascular and metabolic disorders. The French Society of Research and Sleep Medicine organized a meeting on OSAS in adolescents. A multidisciplinary group of specialists (pulmonologists, pediatricians, ENT and maxillo-facial surgeons, dentofacial orthopedists/orthodontists, myofunctional therapists and sleep specialists) exchanged their experience, discussed publications and drew up a consensus document on the diagnosis and polysomnographic criteria for OSAS in adolescents. They proposed a practical diagnostic guideline and follow-up for these adolescents. OUTLOOK AND CONCLUSION: A good knowledge of the particularities of this pathology by the physician will lead to an early diagnosis, propose adapted multifactorial treatments and avoid the deleterious consequences of this pathology at adult age.
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Currie AC, Kaur V, Carey I, Al-Rubaye H, Mahawar K, Madhok B, Small P, McGlone ER, Khan OA. Obstructive sleep apnea remission following bariatric surgery: a national registry cohort study. Surg Obes Relat Dis 2021; 17:1576-1582. [PMID: 34187745 DOI: 10.1016/j.soard.2021.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is strongly associated with metabolic syndrome. Bariatric surgery is an effective available treatment for OSA; however, limited research predicts which patients undergoing bariatric surgery will undergo OSA resolution. OBJECTIVES To determine perioperative predictors for OSA resolution following bariatric surgery using a national database. SETTING United Kingdom national bariatric surgery database. METHODS The UK National Bariatric Surgery Registry (NBSR) was interrogated to identify all patients with OSA that underwent primary bariatric surgery between January 2009 and June 2017. Those with at least 1 follow-up recording postoperative OSA status were selected for further analysis. Demographic, pre- and postoperative outcomes were collected and analyzed. Poisson multivariate regression was conducted to identify predictors of OSA remission. RESULTS A total of 4015 bariatric cases were eligible for inclusion: 2482 (61.8%) patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), 1196 (29.8%) sleeve gastrectomy (LSG), and 337 (8.4%) adjustable gastric banding (LAGB). Overall, the mean excess weight loss (EWL) % for the whole group was 61.2 (SD ± 27.2). OSA resolution was recorded in 2377 (59.2%) patients. Following Poisson regression, LRYGB (risk ratio [RR], 1.49 confidence interval [CI] 1.25-1.78) and LSG (RR, 1.46 [CI 1.22-1.75] were associated with approximately 50% increased likelihood of OSA remission compared with LAGB. Greater weight loss following intervention was associated with greater likelihood of OSA remission, while both greater age and greater preoperative body mass index (BMI) were associated with reduced likelihood of OSA remission (P < .001). CONCLUSION This study demonstrated that metabolic surgery results in OSA remission in the majority of patients with obesity. Younger age, lower BMI preprocedure, greater %EWL and the use of LSG or LRYGB positively predicted OSA remission.
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Affiliation(s)
- Andrew C Currie
- Department of Bariatric Surgery, Ashford & St Peter's Hospital NHS Trust, Chertsey, United Kingdom.
| | - Vasha Kaur
- Department of Upper GI Surgery, Epsom & St Helier NHS Trust, Epsom, United Kingdom
| | - Iain Carey
- Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Hussein Al-Rubaye
- Department of General Surgery, Ashford & St Peter's Hospital NHS Trust, Chertsey, United Kingdom
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Brijesh Madhok
- East Midlands Bariatric and Metabolic Institute, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, United Kingdom
| | - Peter Small
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Emma Rose McGlone
- Department of Metabolic and Investigative Medicine, Commonwealth Building, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Omar A Khan
- Department of Upper Gastrointestinal and Bariatric Surgery, St George's Hospital, London, United Kingdom & Population Health Research Institute, St George's, University of London, London, United Kingdom
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Herrmann BW, Campbell K, Meier M, Haemer M, Crowder R, Tholen K, Hoefner-Notz R, Nguyen T, Friedman NR. Parental Perception of Weight Status for Adenotonsillectomy Patients. Laryngoscope 2021; 131:2121-2125. [PMID: 33569790 PMCID: PMC8355242 DOI: 10.1002/lary.29445] [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: 01/05/2021] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Weight status can affect outcomes in pediatric adenotonsillectomy performed for obstructive sleep disordered breathing. Parents frequently underestimate their child's weight and are unaware weight status may affect adenotonsillectomy success. Accurate understanding of a child's weight status is important for shared decision making with the family and perioperative care. The purpose of this study is to analyze the accuracy of the parent's perception of their child's weight status. METHODS A retrospective analysis was performed of prospective data collected from families of children undergoing adenotonsillectomy from June 2018 through June 2019. RESULTS A total of 522 children met the inclusion criteria. Two hundred and thirty-two children were either overweight (n = 46, 9%) or obese (n = 186, 36%). Among parents of this cohort whose children were overweight or obese, 74 (32%) erroneously reported that their child was normal weight. For the 290 nonoverweight children, 99% of parents accurately reported weight status. After adjusting for ethnicity, race, BMI%, and sex, for every 1-year increase in age of the child, the odds of the parent correctly identifying their child as overweight increased by a factor of 1.18 (95% CI: 1.09, 1.27). CONCLUSION One-third of families with children who were overweight or obese undergoing adenotonsillectomy for obstructive sleep disordered breathing underestimated their child's weight. This study highlights the need to facilitate family understanding of weight status' potential impact on both obstructive sleep disordered breathing severity and adenotonsillectomy success, especially for younger children. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2121-2125, 2021.
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Affiliation(s)
- Brian W Herrmann
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO
| | | | - Maxene Meier
- The Center for Research in Outcomes for Children’s Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Matthew Haemer
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO
| | - Renee Crowder
- University of Colorado School of Medicine, Aurora, CO
| | - Kaitlyn Tholen
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO
| | - Regina Hoefner-Notz
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO
| | - Thanh Nguyen
- University of Colorado School of Medicine, Aurora, CO
- Division of Pediatric Anesthesia, Children’s Hospital Colorado, Aurora, CO
| | - Norman R Friedman
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO
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Xu ZF, Ni X. Debates in pediatric obstructive sleep apnea treatment. World J Otorhinolaryngol Head Neck Surg 2021; 7:194-200. [PMID: 34430827 PMCID: PMC8356119 DOI: 10.1016/j.wjorl.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/01/2022] Open
Abstract
Pediatric obstructive sleep apnea (OSA) is among the most common sleep-disordered breathing (SDB) diseases in children. Its high prevalence and multiple systemic complications lead to increasing numbers of children and families affected by OSA. Timely diagnosis and effective intervention in children with this condition is extremely important in improving their prognosis. The major approaches in the treatment of OSA in children are to eliminate the causes of upper airway obstruction and prevent and treat complications. Considering the specific individual differences in children's growth and development, as well as the diversity of etiologies in children's OSA, pediatric treatment strategies need to be precise, multidisciplinary, and individualized. First-line clinical treatment consists of surgical (adenotonsillectomy) and non-surgical therapies [including anti-inflammatory medications and non-invasive ventilation (NIV)]. However, a considerable controversy exists concerning the indications, treatment standards, and the evaluation of the efficacy of the aforementioned treatment methods. In this review, reviews and assessment of literature studies and multidisciplinary clinical experience were performed to analyze the application of each treatment and discuss controversial issues and future research directions. We suggest that the above interventions should be tailored to each child's needs, comorbidities, and the availability and expertise of the practitioner. The ideal case is when a multidisciplinary team of doctors together with the patients and their parents, or guardians, have a thorough discussion regarding the benefits and risks of all available treatment options and all agree on an effective treatment plan.
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Affiliation(s)
- Zhi-Fei Xu
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
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17
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Gonzalez DO, Michalsky MP. Update on pediatric metabolic and bariatric surgery. Pediatr Obes 2021; 16:e12794. [PMID: 34041862 DOI: 10.1111/ijpo.12794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
The prevalence of childhood obesity has risen sharply over the last several decades and poses a significant threat to the health and well-being of today's youth. Childhood-onset obesity is associated with a number of cardiometabolic consequences, which contribute to diminished quality of life. Metabolic and bariatric surgery offers a powerful treatment paradigm with positive long-term health effects. A growing body of literature supports the notion that earlier intervention in younger patients results in long-term health benefits. The development of a multidisciplinary care model and best practice guidelines are central to providing optimal care for this vulnerable patient population. Although the outcomes of metabolic and bariatric surgery in pediatric patients are reassuring and support the ongoing utilization of this important treatment paradigm, a number of significant challenges remain regarding access to care. As the literature continues to support earlier intervention for youth with severe obesity, future efforts should address these challenges to ensure that eligible patients are referred in timely fashion.
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Affiliation(s)
- Dani O Gonzalez
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
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18
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Hines S, Pickett K, Tholen K, Handley E, Friedman NR. Tonsillectomy Outcomes for Children With Severe Obesity. Laryngoscope 2021; 132:461-469. [PMID: 34191279 DOI: 10.1002/lary.29712] [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: 05/06/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the success of an adenotonsillectomy (T&A) in treating children with severe obesity utilizing a more accurate obesity scale. STUDY DESIGN Retrospective cohort. METHODS A retrospective cohort of children with obesity between 5 and 10 years of age who underwent a T&A at Children's Hospital of Colorado (CHCO) was used. This study also utilized publicly available data from the Childhood Adenotonsillectomy Trial (CHAT) study. The cohort was divided into three obesity classes using age- and sex-specific body mass index (BMI) expressed as a percentage of the 95th percentile (%BMIp95) and compared for operative success differences. RESULTS There were 132 patients included in our primary analysis, with obesity distribution as follows: Class 1 to 53 patients (40%), Class 2 to 45 patients (34%), and Class 3 to 34 patients (26%). Overall, 52 patients (35.9%) experienced a cure (obstructive apnea/hypopnea index [OAHI] <1), with 27 (52%) patients in Class 1 obesity, 18 (35%) in Class 2, and 7 (13%) in Class 3. Class 3 had a significantly lower obstructive sleep apnea cure rate compared with Class 1 patients (P = .013), but after adjusting for covariates, this difference was no longer present (P > .05). There was no significant difference in the preoperative to postoperative percent change in mean oxygen saturation (P = .82 CHCO, P = .43 CHAT), oxygen nadir (P = .20 CHCO, P = .49 CHAT), or OAHI (P = .12 CHCO, P = .26 CHAT) between the obesity classes. CONCLUSION After adjusting for covariates, children with Class 3 obesity are as likely to be cured with a T&A as those with Class 1 obesity. A T&A should be considered a first line treatment for all children with obesity. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Susan Hines
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, U.S.A.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Kaci Pickett
- Center for Research in Outcomes for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Kaitlyn Tholen
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School, Aurora, Colorado, U.S.A.,University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Elyse Handley
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School, Aurora, Colorado, U.S.A.,University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Norman R Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School, Aurora, Colorado, U.S.A.,University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, U.S.A
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Li C, Kou YF, Ishman SL. Pediatric OSA: Evidence-Based Review of Treatment Results. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00348-4] [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]
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Abstract
Childhood obesity can lead to comorbidities that cause significant decrease in health-related quality of life and early mortality. Recognition of obesity as a disease of polygenic etiology can help deter implicit bias. Current guidelines for treating severe obesity in children recommend referral to a multidisciplinary treatment center that offers metabolic and bariatric surgery at any age when a child develops a body mass index that is greater than 120% of the 95th percentile. Obesity medications and lifestyle counseling about diet and exercise are not adequate treatment for severe childhood obesity. Early referral can significantly improve quality and quantity of life.
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Affiliation(s)
- Adi Steinhart
- Department of Pediatrics, Stanford University School of Medicine, 1017 Paradise Way, Palo Alto, CA 94306, USA
| | - Deborah Tsao
- Stanford University School of Medicine, 227 Ayrshire Farm Ln (Apt 203), Stanford, CA 94305, USA
| | - Janey S A Pratt
- Division of Pediatric Surgery, Stanford University School of Medicine, Lucille Packard Children's Hospital, M166 Alway Building, 300 Pasteur Drive, Stanford, CA 94305, USA.
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21
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Moore JM, Glover JJ, Jackson BM, Coughlin CR, Kelsey MM, Inge TH, Boles RE. Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation. Surg Obes Relat Dis 2021; 17:425-433. [PMID: 33191162 PMCID: PMC7880864 DOI: 10.1016/j.soard.2020.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND As severe obesity continues to rise among youth, metabolic and bariatric surgery (MBS) will increasingly be used as a treatment of choice for durable weight loss and improvement of obesity-related complications. MBS for youth with intellectual and developmental disabilities (IDD) and for preadolescents has raised ethical questions. OBJECTIVES The purpose of this article is to present the creation and application of an ethical framework that supports why MBS should be considered in pediatrics based on the principle of justice without automatic exclusions. This framework also provides a guide for how to conduct a robust, ethically grounded evaluation of pediatric patients presenting for MBS in general, and among subpopulations including youth with IDD and preadolescents. SETTING Academic medical center, United States. METHODS An ethical framework was developed and applied through a collaboration between an MBS center at a children's hospital and the institution's ethics consult service. RESULTS Application of the ethical framework to address 4 core ethical questions is illustrated using 2 hypothetical cases: 1 that highlights an adolescent with IDD and 1 that highlights a preadolescent. CONCLUSIONS We have demonstrated the application of a novel, overarching framework to conduct the ethical evaluation of youth presenting for MBS. This framework resulted from a collaboration between MBS and ethics consult teams and has the potential to be used as a prototype for other youth-focused MBS programs. Next steps include prospective data collection to test the framework and determine its validity in the target population.
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Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
| | - Jacqueline J Glover
- Department of Pediatrics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian M Jackson
- Department of Pediatrics, Section of Pediatric Critical Care, Center for Bioethics and Humanities, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Curtis R Coughlin
- Department of Pediatrics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
| | - Megan M Kelsey
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Thomas H Inge
- Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Richard E Boles
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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22
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Kaar JL, Morelli N, Russell SP, Talker I, Moore JM, Inge TH, Nadeau KJ, Hawkins SMM, Aloia MS, Simon SL. Obstructive sleep apnea and early weight loss among adolescents undergoing bariatric surgery. Surg Obes Relat Dis 2020; 17:711-717. [PMID: 33478907 DOI: 10.1016/j.soard.2020.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/21/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known regarding obstructive sleep apnea's (OSA's) prevalence or the factors related to OSA remission post-metabolic bariatric surgery (MBS) in adolescents. OBJECTIVES To identify the baseline OSA prevalence in adolescents with severe obesity and examine factors associated with post-MBS OSA remission. SETTING Tertiary-care children's hospital. METHODS We conducted a retrospective chart review of 81 patients pre-MBS with OSA assessments done between June 2017 to September 2020 to collect demographic characteristics; co-morbidities; polysomnography (PSG) results, if indicated; and weight data. Chi-square or Mann-Whitney tests compared baseline characteristics and surgical outcomes by pre-MBS OSA status. McNemar's test or t tests assessed differences in baseline characteristics, stratified by remission versus no remission of OSA. RESULTS The patients were 71% female, had an average age of 16.9 ± 2.0 years, and had a mean body mass index (BMI) of 47.9 ± 7.3 kg/m2. Half (50%) of the patients were Hispanic and 20% had type 2 diabetes. The OSA prevalence, defined as an Obstructive Apnea Hypopnea Index (OAHI) score ≥5, was 54% pre-MBS (n = 44), with 43% having severe OSA (OAHI > 30). Those with OSA were older (17.3 versus 16.4 yr, respectively; P = .05), more likely to be male (79% versus 42%, respectively; P = .022), and had higher baseline weights (142.0 versus 126.4 kg, respectively; P = .001) than those without OSA. Of the 23 patients with a post-MBS PSG result (average 5 mo post MBS), 15 (66%) had remission of OSA. Patients with OSA remission had a lower average pre-MBS BMI (46.0 versus 57.7 kg/m2, respectively; P < .001) and weight (132.9 versus 172.6 kg, respectively; P = .002) but no significant differences in percentage weight loss through 12 months post MBS versus those with continued OSA. CONCLUSION The OSA prevalence in an adolescent MBS population was higher than that in the general adolescent population with severe obesity. Remission of OSA was correlated with lower pre-MBS BMI and weight, but not weight loss within the first year post-MBS.
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Affiliation(s)
- Jill L Kaar
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Nazeen Morelli
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samuel P Russell
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ishaah Talker
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jaime M Moore
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Thomas H Inge
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J Nadeau
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephen M M Hawkins
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Stacey L Simon
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Valenzano A, Tartaglia N, Ambrosi A, Tafuri D, Monda M, Messina A, Sessa F, Campanozzi A, Monda V, Cibelli G, Messina G, Polito R. The Metabolic Rearrangements of Bariatric Surgery: Focus on Orexin-A and the Adiponectin System. J Clin Med 2020; 9:jcm9103327. [PMID: 33081283 PMCID: PMC7602946 DOI: 10.3390/jcm9103327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 12/28/2022] Open
Abstract
The accumulation of adipose tissue represents one of the characteristics of obesity, increasing the risk of developing correlated obesity diseases such as cardiovascular disease, type 2 diabetes, cancer, and immune diseases. Visceral adipose tissue accumulation leads to chronic low inflammation inducing an imbalanced adipokine secretion. Among these adipokines, Adiponectin is an important metabolic and inflammatory mediator. It is also known that adipose tissue is influenced by Orexin-A levels, a neuropeptide produced in the lateral hypothalamus. Adiponectin and Orexin-A are strongly decreased in obesity and are associated with metabolic and inflammatory pathways. The aim of this review was to investigate the involvement of the autonomic nervous system focusing on Adiponectin and Orexin-A after bariatric surgery. After bariatric surgery, Adiponectin and Orexin-A levels are strongly increased independently of weight loss showing that hormone increases are also attributable to a rearrangement of metabolic and inflammatory mediators. The restriction of food intake and malabsorption are not sufficient to clarify the clinical effects of bariatric surgery suggesting the involvement of neuro-hormonal feedback loops and also of mediators such as Adiponectin and Orexin-A.
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Affiliation(s)
- Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (A.V.); (F.S.); (G.C.)
| | - Nicola Tartaglia
- General Surgery, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (N.T.); (A.A.)
| | - Antonio Ambrosi
- General Surgery, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (N.T.); (A.A.)
| | - Domenico Tafuri
- Department of Motor Sciences and Wellness, University of Naples “Parthenope”, 80133 Naples, Italy;
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (M.M.); (A.M.); (V.M.)
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (M.M.); (A.M.); (V.M.)
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (A.V.); (F.S.); (G.C.)
| | - Angelo Campanozzi
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy;
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (M.M.); (A.M.); (V.M.)
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (A.V.); (F.S.); (G.C.)
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (A.V.); (F.S.); (G.C.)
- Correspondence: (G.M.); (R.P.); Tel.: +39-0881588095 (G.M.)
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (A.V.); (F.S.); (G.C.)
- Correspondence: (G.M.); (R.P.); Tel.: +39-0881588095 (G.M.)
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Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review. SLEEP DISORDERS 2020; 2020:7987208. [PMID: 32695520 PMCID: PMC7355373 DOI: 10.1155/2020/7987208] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
Abstract
Continuous positive airway pressure (CPAP) is considered first-line treatment in the management of pediatric patients without a surgically correctible cause of obstruction who have confirmed moderate-to-severe obstructive sleep apnea (OSA). The evidence supports its reduction on patient morbidity and positive influence on neurobehavioral outcome. Unfortunately, in clinical practice, many patients either refuse CPAP or cannot tolerate it. An update on alternative approaches to CPAP for the management of OSA is discussed in this review, supported by the findings of systematic reviews and recent clinical studies. Alternative approaches to CPAP and adenotonsillectomy for the management of OSA include weight management, positional therapy, pharmacotherapy, high-flow nasal cannula, and the use of orthodontic procedures, such as rapid maxillary expansion and mandibular advancement devices. Surgical procedures for the management of OSA include tongue-base reduction surgery, uvulopalatopharyngoplasty, lingual tonsillectomy, supraglottoplasty, tracheostomy, and hypoglossal nerve stimulation. It is expected that this review will provide an update on the evidence available regarding alternative treatment approaches to CPAP for clinicians who manage patients with pediatric OSA in daily clinical practice.
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Timmerman M, Basille D, Basille-Fantinato A, Baud ME, Rebibo L, Andrejak C, Jounieaux V, Lalau JD. Short-Term Assessment of Obstructive Sleep Apnea Syndrome Remission Rate after Sleeve Gastrectomy: a Cohort Study. Obes Surg 2020; 29:3690-3697. [PMID: 31346929 DOI: 10.1007/s11695-019-04110-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Severe obesity is associated with a high prevalence of moderate-to-severe obstructive sleep apnea syndrome (OSA). Bariatric surgery has been shown to effectively reduce excess weight and comorbidities. METHODS We evaluated the remission rate of moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥ 15) following sleeve gastrectomy. We performed a single-center retrospective chart review of all patients who underwent preoperative polysomnography (PSG) or polygraphy before primary sleeve gastrectomy. Patients with moderate-to-severe OSA treated by continuous positive airway pressure (CPAP) also underwent postoperative PSG. Bivariate analysis was performed to evaluate the criteria associated with remission of moderate-to-severe OSA. RESULTS From 2013 to 2018, 39 of 162 patients (24.1%) scheduled for sleeve gastrectomy (SG) presented moderate-to-severe OSA requiring CPAP. Postoperative PSG was performed in 36 patients a mean of 9.9 ± 6.1 months after SG. Mean BMI decreased from 47.4 ± 8.4 to 36.3 ± 7.1 kg/m2 (p < 0.001), and all patients reported clinical improvement of OSA symptoms. A remission of moderate-to-severe OSA was observed in 72.2% of patients with a mean decrease of AHI from 45.8 events/h to 11.3 events/h (p < 0.001). Postoperative neck circumference was the only factor associated with OSA remission. CONCLUSION SG is associated with a rapid improvement of moderate-to-severe OSA partially as a result of a reduction of neck circumference. However, the absence of correlation with excess weight loss suggests that other weight-independent factors may also be involved.
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Affiliation(s)
- Marine Timmerman
- Department of Endocrinology, Metabolic Diseases and Nutrition, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Damien Basille
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France.
- AGIR Unit, University Picardie Jules Verne, 80054, Amiens Cedex, France.
| | | | - Mickaël E Baud
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Lionel Rebibo
- Department of Digestive Surgery, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, 46 rue Henri Huchard, F-75018, Paris, France
| | - Claire Andrejak
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- AGIR Unit, University Picardie Jules Verne, 80054, Amiens Cedex, France
- Sleep and Vigilance Disorder Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Vincent Jounieaux
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- AGIR Unit, University Picardie Jules Verne, 80054, Amiens Cedex, France
- Sleep and Vigilance Disorder Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Jean-Daniel Lalau
- Department of Endocrinology, Metabolic Diseases and Nutrition, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- PériTox Unit, UMR-I 01, University Picardie Jules Verne, 80054, Amiens Cedex, France
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26
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Barnett S, Li A. Orexin in Respiratory and Autonomic Regulation, Health and Diseases. Compr Physiol 2020; 10:345-363. [DOI: 10.1002/cphy.c190013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Kanney ML, Harford KL, Raol N, Leu RM. Obstructive sleep apnea in pediatric obesity and the effects of sleeve gastrectomy. Semin Pediatr Surg 2020; 29:150887. [PMID: 32238281 DOI: 10.1016/j.sempedsurg.2020.150887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The prevalence of severe pediatric obesity is rising and poses many adverse health risks. Children with obesity are at increased risk of several cardiovascular and metabolic diseases. They are also more likely to have obstructive sleep apnea (OSA), which increases the risk of cardiovascular and metabolic problems. In this review, we examine the relationship between OSA and obesity, improvements in OSA after non-surgical and surgical weight loss, and explore potential directions for future research.
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Affiliation(s)
- Michelle L Kanney
- Division of Pulmonology, Allergy, Cystic Fibrosis and Sleep Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kelli-Lee Harford
- Division of Pulmonology, Allergy, Cystic Fibrosis and Sleep Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Roberta M Leu
- Division of Pulmonology, Allergy, Cystic Fibrosis and Sleep Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.
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28
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Pratt JS, Roque SS, Valera R, Czepiel KS, Tsao DD, Stanford FC. Preoperative considerations for the pediatric patient undergoing metabolic and bariatric surgery. Semin Pediatr Surg 2020; 29:150890. [PMID: 32238283 PMCID: PMC7238975 DOI: 10.1016/j.sempedsurg.2020.150890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
To ensure successful outcomes in pediatric patients with severe obesity who undergo metabolic and bariatric surgery (MBS), a number of pre-operative patient management options should be considered. This manuscript will review the indications and contraindications of MBS and special considerations for youth who might benefit from MBS. The treatment team conducts a thorough pre-operative evaluation, assessing risks and benefits of surgical intervention, and prepares patients and families to be successful with MBS by providing education about the surgical intervention and lifestyle changes that will be necessary. This article reviews the pre-operative considerations for adolescents with severe obesity who are being considered for MBS, based upon recent clinical practice guidelines.
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Affiliation(s)
- Janey S.A. Pratt
- Stanford University School of Medicine, Palo Alto, CA, USA,Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA,Corresponding author at: Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Always Building, M116, Stanford, CA 94305, USA, (J.S.A. Pratt)
| | | | - Ruben Valera
- Tufts University School of Medicine, Boston, MA, USA
| | - Kathryn S. Czepiel
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA,Internal Medicine- Neuroendocrine Division and Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
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29
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Mental health, loss of control eating, and cognitive functioning in adolescents undergoing bariatric surgery. Semin Pediatr Surg 2020; 29:150892. [PMID: 32238286 DOI: 10.1016/j.sempedsurg.2020.150892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bariatric surgery is an effective treatment for severe obesity in adolescence. Nevertheless, much remains to be understood regarding the impact of surgery on mental health, eating behaviors, and cognition. We review the findings related to mental health both before and after surgery as well as long-term changes in psychopathology, including suicide risk. Overall, adolescents with and without a history of psychopathology lose weight at similar rates. At the same time, there is an increased risk for suicide that requires further study. Regarding alcohol and substance use, this population reports lower rates of consumption than age related non-obese cohorts. Nevertheless the impact of altered anatomy and metabolism on alcohol ingestion in a population at risk for substance use is concerning. Eating behaviors, specifically loss of control eating, are discussed. Finally, we include discussion of the cognitive changes occurring perioperatively and considerations for adolescents with cognitive impairments. Clinical recommendations and suggestions for future research are discussed.
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30
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Roberts CA. Physical and Psychological Effects of Bariatric Surgery on Obese Adolescents: A Review. Front Pediatr 2020; 8:591598. [PMID: 33585363 PMCID: PMC7873639 DOI: 10.3389/fped.2020.591598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022] Open
Abstract
The worldwide obesity crisis is not isolated to adults; rather, obesity in adolescents has reached epidemic levels as well. Bariatric surgery continues to be one of the most effective treatments for obesity, both in adults and adolescents, with new evidence continually emerging; however, research surrounding outcomes of these procedures in younger patients is limited in comparison with data available for adults. Further, it is important to examine psychological aspects of obesity in adolescents, as well as effects of surgery on mental health endpoints. Conditions such as anxiety, depression, anger, and disruptive behavior show increased prevalence among obese adolescents, but minimal research exists to examine changes in such conditions following bariatric surgery. Additionally, there is growing evidence of a bidirectional relationship between sleep (quality; disorders) and the development of obesity, and the effects of this relationship are particularly pronounced in the vulnerable adolescent population. This review aims to compile and discuss the results of literature within the last 5 years with regard to overall efficacy of bariatric surgery specifically in adolescent patients in terms of weight and body mass index (BMI) reduction, hormonal changes, and co-morbidity resolution, as well as data surrounding sleep and psychological outcomes. Race, ethnicity, and socioeconomic status were also examined. From this review, we conclude that current research supports bariatric surgery in adolescents as an effective method of treatment for obesity and related co-morbidities; however, minimal long-term data exists to adequately assess efficacy and trends into adulthood. These areas are ripe for future study.
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Affiliation(s)
- Cherie A Roberts
- Department of Nutrition, Columbia University, New York, NY, United States.,Department of Biomedical Sciences, Touro College of Osteopathic Medicine-Harlem, New York, NY, United States.,Department of Osteopathic Medicine, Touro College of Osteopathic Medicine-Harlem, New York, NY, United States
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31
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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.
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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.
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32
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Yu JL, Afolabi‐Brown O. Updates on management of pediatric obstructive sleep apnea. Pediatr Investig 2019; 3:228-235. [PMID: 32851328 PMCID: PMC7331384 DOI: 10.1002/ped4.12164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/20/2019] [Indexed: 11/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) affects about 1%-5% of the pediatric population. The consequences of untreated OSA in children include neurocognitive deficits, behavioral problems, poor school performance as well as systemic and pulmonary hypertension. The treatment options for pediatric OSA are numerous with a variety of surgical and non-surgical interventions. As our understanding of the complexities of OSA grows, the options for management have continued to expand as well. The objectives of this review are to describe the commonly prescribed treatments for pediatric OSA including adenotonsillectomy as well as use of positive airway pressure. We also highlight other surgical and non-surgical interventions available. In addition, we provide updates on current research focusing on newer diagnostic and experimental treatment modalities.
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Affiliation(s)
- Jason L. Yu
- Department of Otorhinolaryngology‐Head and Neck SurgeryPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
- Division of Sleep MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Olufunke Afolabi‐Brown
- Division of Pulmonary MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of PediatricsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
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33
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Huang R, Ding X, Fu H, Cai Q. Potential mechanisms of sleeve gastrectomy for reducing weight and improving metabolism in patients with obesity. Surg Obes Relat Dis 2019; 15:1861-1871. [DOI: 10.1016/j.soard.2019.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 02/07/2023]
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34
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Nguyen XL, Briffod J, Couloigner V, Darqué F, Kerbrat JB, Vecchierini MF. [Adolescent obstructive sleep apnoea syndrome: Characteristics and treatment]. Rev Mal Respir 2019; 36:697-706. [PMID: 31255317 DOI: 10.1016/j.rmr.2018.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/29/2018] [Indexed: 12/28/2022]
Abstract
Although the prevalence of the obstructive sleep apnoea syndrome (OSAS) is high in adolescents, studies pertaining to adolescent OSAS are less numerous than childhood studies. Cases of adolescent OSAS may consist of residual OSAS after adenotonsillectomy, but most often are de novo cases. Major pathophysiological factors are weight excess or even high-grade obesity, and the association of upper airway narrowing and tonsillar hypertrophy (pharyngeal, palatal or even lingual). ENT and systematic orthodontic assessments are the main points. In case of predisposing factors such as dental, occlusal or dento-facial abnormalities, a specific orthodontic treatment can be discussed. First line treatment is surgical adenotonsillectomy; surgical reduction of the lingual tonsils is seldom required. CPAP treatment may be indicated in the case of severe comorbidities (craniofacial malformations, neuromuscular diseases…) or in obese adolescents with severe residual OSAS. Treatment of adolescent OSAS has to be comprehensive and multidisciplinary, taking into account the specific treatments of obesity and abnormal sleep/wake rhythms.
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Affiliation(s)
- X-L Nguyen
- Unité somnologie et fonction respiratoire, hôpital St-Antoine, 75012 Paris, France
| | - J Briffod
- Centre médical spécialisé de l'enfant et de l'adolescent, 17, rue Froment, 75011 Paris, France
| | - V Couloigner
- Service d'ORL pédiatrique, hôpital Necker-Enfants Malades, université Paris Descartes, AP-HP, 75015 Paris, France
| | - F Darqué
- Unité d'orthopédie dento-faciale, hôpital Pellegrin, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - J-B Kerbrat
- Pathologies du sommeil, groupe hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France
| | - M-F Vecchierini
- Centre du sommeil et de la vigilance, Hôtel-Dieu, 1, place du Parvis Notre-Dame, 75181 Paris cedex 04, France.
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35
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Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Ann N Y Acad Sci 2019; 1411:166-183. [PMID: 29377201 DOI: 10.1111/nyas.13602] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 02/06/2023]
Abstract
Obesity in childhood remains a significant and prevalent public health concern. Excess adiposity in youth is a marker of increased cardiometabolic risk (CMR) in adolescents and adults. Several longitudinal studies confirm the strong association of pediatric obesity with the persistence of adult obesity and the future development of cardiovascular disease, diabetes, and increased risk of death. The economic and social impact of childhood obesity is further exacerbated by the early onset of the chronic disease burden in young adults during their peak productivity years. Furthermore, rising prevalence rates of severe obesity in youth from disadvantaged and/or minority backgrounds have prompted the creation of additional classification schemes for severe obesity to improve CMR stratification. Current guidelines focus on primary obesity prevention efforts, as well as screening for clustering of multiple CMR factors to target interventions. This review summarizes the scope of the pediatric obesity epidemic, the new severe obesity classification scheme, and examines the association of excess adiposity with cardiovascular and metabolic risk. We will also discuss potential questions for future investigation.
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Affiliation(s)
- Stephanie T Chung
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland.,Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anthony U Onuzuruike
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland
| | - Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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36
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Adolescent Bariatric Surgery: Current Concepts and Future Directions. CURRENT SURGERY REPORTS 2019. [DOI: 10.1007/s40137-019-0232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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Keefe KR, Patel PN, Levi JR. The shifting relationship between weight and pediatric obstructive sleep apnea: A historical review. Laryngoscope 2018; 129:2414-2419. [PMID: 30474230 DOI: 10.1002/lary.27606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES For more than a century, pediatric obstructive sleep apnea (OSA) was associated with failure to thrive. However, that association has faded over the last few decades. A 21st century child with OSA is much more likely to be overweight than underweight. This raises the question: Has pediatric OSA changed over time, or has the rise of childhood obesity in the United States created a new, separate disease? This literature review explores the historical shift in the relationship between weight and OSA, and the associated changes in treatment. RESULTS We demonstrate a clear transition in the prevalence of failure to thrive and obesity in the OSA literature in the mid-2000s. What is less clear is whether these two clinical phenotypes should be considered two distinct diseases, or whether subtle differences in one set of pathophysiologic pathways-adenotonsillar hypertrophy, altered inflammation, and increased energy expenditure-can lead to divergent metabolic outcomes. More research is needed to fully elucidate the pathophysiology of OSA in children with obesity. CONCLUSIONS We may need new and different treatments for obesity-associated OSA as adenotonsillectomy-which is effective at reversing failure to thrive in OSA-is not as effective at treating OSA in children with obesity. One option is drug-induced sleep endoscopy, which could personalize and improve surgical treatment of OSA. There is some evidence that therapies used for OSA in adults (e.g., weight loss and positive airway pressure) are also helpful for overweight/obese children with OSA. Laryngoscope, 129:2414-2419, 2019.
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Affiliation(s)
| | - Prachi N Patel
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts.,Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts, U.S.A
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Pratt JSA, Browne A, Browne NT, Bruzoni M, Cohen M, Desai A, Inge T, Linden BC, Mattar SG, Michalsky M, Podkameni D, Reichard KW, Stanford FC, Zeller MH, Zitsman J. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surg Obes Relat Dis 2018; 14:882-901. [PMID: 30077361 PMCID: PMC6097871 DOI: 10.1016/j.soard.2018.03.019] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/11/2022]
Abstract
The American Society for Metabolic and Bariatric Surgery Pediatric Committee updated their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009-2017) with 1387 articles and other supporting evidence through February 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the Centers for Disease Control and Prevention age- and sex-matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with class II obesity and a co-morbidity (listed in the guidelines), or with class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities.
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Affiliation(s)
- Janey S A Pratt
- Lucille Packard Children's Hospital and Stanford University School of Medicine Stanford, California.
| | - Allen Browne
- Diplomate American Board of Obesity Medicine Falmouth, Maine
| | - Nancy T Browne
- WOW Pediatric Weight Management Clinic, EMMC, Orono, Maine
| | - Matias Bruzoni
- Lucille Packard Children's Hospital and Stanford University School of Medicine Stanford, California
| | - Megan Cohen
- Nemours/Alfred I. DuPont Hospital for Children Wilmington, Delaware
| | | | - Thomas Inge
- University of Colorado, Denver and Children's Hospital of Colorado Aurora, Colorado
| | - Bradley C Linden
- Pediatric Surgical Associates and Allina Health Minneapolis, Minnesota
| | - Samer G Mattar
- Swedish Weight Loss Services Swedish Medical Center Seattle, Washington
| | - Marc Michalsky
- Nationwide Children's Hospital and The Ohio State University Columbus, Ohio
| | - David Podkameni
- Banner Gateway Medical Center and University of Arizona Phoenix, Arizona
| | - Kirk W Reichard
- Nemours/Alfred I. DuPont Hospital for Children Wilmington, Delaware
| | - Fatima Cody Stanford
- Diplomate American Board of Obesity Medicine Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - Meg H Zeller
- Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
| | - Jeffrey Zitsman
- Morgan Stanley Children's Hospital of NY Presbyterian and Columbia University Medical Center New York, New York
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40
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Abstract
PURPOSE OF REVIEW In spite of the increasing prevalence of severe and complex obesity in children, surgery as a potential management option is still not widely accepted. The purpose of this review is to examine the evidence for surgical options in the severely obese paediatric population. Increasing evidence supports early rather than later use of bariatric surgery in the treatment of extreme obesity. RECENT FINDINGS Prior to 2007, the feasibility and safety of surgery have been reported by predominantly small, sporadic single-centre retrospective case series. Increasing long-term data is now emerging due to the formation of multi-centre prospective national consortiums with two large, prospective long-term outcome studies published within the last year aiding our understanding of the efficacy and safety of bariatric surgery within the adolescent population. It is increasingly clear that adolescent bariatric surgery outcomes are comparable to adults, with similar sustainable weight loss, resolution of co-morbidities and complication rates. However, these studies are solely from dedicated specialist adolescent centres and results may not be reproducible if not performed in regulated environments with specialist multi-disciplinary teams.
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Affiliation(s)
- Natalie Durkin
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, SE9 5RS, UK
| | - Ashish P Desai
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, SE9 5RS, UK.
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