Weight Loss as the First-Line Therapy in Patients with Severe Obesity and Obstructive Sleep Apnea Syndrome: the Role of
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ORIGINAL CONTRIBUTIONS
Weight Loss as the First-Line Therapy in Patients with Severe Obesity and Obstructive Sleep Apnea Syndrome: the Role of Laparoscopic Sleeve Gastrectomy Bilge Yılmaz Kara 1 Ünal Şahin 1
&
Süleyman Kalcan 2 & Songül Özyurt 1 & Aziz Gümüş 1 & Neslihan Özçelik 1 & Dilek Karadoğan 1 &
Received: 25 August 2020 / Revised: 14 October 2020 / Accepted: 21 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The objective of this study is to investigate the effects of laparoscopic sleeve gastrectomy (LSG) on the polysomnographic parameters related to OSAS. Materials and Methods We conducted this 3-year prospective cohort study in a tertiary care center between December 2016 and December 2019. In total, we enrolled 31 patients with severe obesity who underwent full-night polysomnography (PSG) before LSG. Later, the patients were re-evaluated by full-night PSG 12 months after the surgery. Results The mean age of the patients was 44.1 ± 9.6 years. The mean body mass index (BMI) decreased significantly from a mean value of 49.8 ± 8.5 kg/m2 at baseline to 33.2 ± 8.2 kg/m2 and a percent BMI (%BMI) reduction of 33.8 ± 10.4% and a percent total weight loss (%TWL) of 35.4 ± 10.8% was achieved on the same day of the postsurgical PSG (p < 0.001). There was a remarkable improvement in the AHI (baseline: 36.1 ± 27.1, 12 months after the surgery: 10.3 ± 11.8; difference: 25.8 ± 22.8 events per hour) (p < 0.001). Importantly, there was a decrease in the percentage of non-rapid eye movement (NREM) 2 (p < 0.001), whereas NREM 3 and REM stages witnessed a significant increase (p = 0.001 and p < 0.001, respectively) after the surgery. Conclusion The results of this study showed that weight loss after LSG yields improvement not only in AHI but also in many polysomnographic parameters such as sleep quality and desaturation indices. Keywords Bariatric surgery . Obesity . Obstructive sleep apnea . Weight loss . Laparoscopic sleeve gastrectomy
Introduction Obesity is a well-known risk factor for obstructive sleep apnea syndrome (OSAS), with strong evidence suggesting that it is also a complication of OSAS [1–3]. The consecutive obstruction of the upper airways of patients with OSAS during sleep causes hypoxemia, which leads to an increased respiratory effort and, subsequently, recurrent arousals (near awakenings), further causing the disruption of sleep architecture. Research
* Bilge Yılmaz Kara [email protected]; [email protected] 1
Department of Pulmonology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
2
Department of General Surgery, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
evidence in the literature suggests that being overweight directly affects the pathophysiology of the narrowing of the upper airways and involvement of the oropharyngeal muscles [4]. Muscles are not solely responsible for causing respiratory obstruction. Moreover, a layer of excess fat along the soft palate and the tonsillar region t
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