The Link Between Weight and Sleep Apnea
More than half of Americans are overweight and roughly 12 million Americans have severe obesity (defined as being 100 pounds or more overweight). Obesity is one of the most important risk factors for the development and progression of OSA. OSA is an independent risk factor for patients undergoing bariatric surgery, in fact, it is estimated that 78% of patients considering bariatric surgery may have OSA, and their patients are 12 to 30 more times to have comorbidities including hypertension, diabetes, and OSA. People who are obese tend to have thicker tissue around the throat that may make them more prone to sleep apnea.
OSA frequently goes undetected and often undiagnosed in the general population and in obese patients who undergo bariatric surgery according to a recent study. As many as five to ten percent of adults – almost 20 million people – in the United States have OSA. 85 to 90% of this population have not been identified.
Most Common Symptoms of OSA
- Morning headaches
- Waking up sweating
- Excessive daytime sleepiness
- Frequent trips to the bathroom during the night
- Problems staying asleep (insomnia)
- Waking up and gasping for air
- Bed partner witnesses apneas
Risk Factors/Predictors of OSA:
- Obesity/BMI >30
- Neck line circumference >17 male/>15” female
- Advanced age (0ver 40)
- Male gender
- Narrow airway
- Enlarged tonsils
- Cranio-facial abnormalities
- Retrognathia (recessed chin)
- Downs syndrome
- Shift workers and commercial truck drivers
- African-Americans have twice the risk versus Caucasians, additionally Asian ethnicity and Hispanic Women show a higher prevalence.
The Bariatric Surgeons Role:
- Every patient should be should be screened for OSA during the patient’s initial doctor’s visit because an OSA diagnosis and treatment prior to surgery is essential to reducing surgical risk.
- Patients should undergo a pre-operative sleep test (polysomnography) to check for the condition, advise researchers.
- As studies have reported, patients with OSA are particularly vulnerable during anesthesia and sedation and are at an increased risk of developing respiratory and cardiopulmonary complications post-operatively.
- Patients with severe sleep apnea should not be considered for outpatient surgery as both anesthesia and post-operative analgesic measures can affect OSA negatively.
- Studies show patients that receive pre-operative CPAP therapy have less post-operative complications than undiagnosed and untreated OSA patients. CPAP therapy is recommended post-operatively as well as to prevent acute airway obstruction in OSA patients, and can be used safely following bariatric surgery.
Bariatric Surgery as a Treatment for Sleep Apnea
Bariatric surgery is one of the most effective treatments for OSA, causing remission in 80 to 85% of cases. Most patients lose between 50 and 80% of their excess body weight 18 to 24 months after surgery. When patients lose weight following surgery, the fatty tissue around the upper airway is decreased which can eliminate or reduce the upper airway collapse that occurs with OSA.
Detailed references available upon request.