Bariatric Surgery and Sleep Apnea

Bariatric Surgery

Bariatric surgery includes procedures designed to reduce oral intake, and thus help patients reduce weight. These are the “gastroplasties”, “banding” and such you hear about on health programs that will make your stomach effectively smaller. People will end up taking smaller meals and lose weight doing so. Bariatric surgery does not include the upper airway surgeries done to open the airway, such as palate or tonsil reductions.

The success rates with bariatric surgery are usually quite good, as long as the patient is motivated to follow all the directions afterwards. Unfortunately, you can “cheat” the beneficial effects of a smaller stomach by loading it with high calorie intake (such as juices, ice cream, gravies, creamy soups). Most of the relapses in weight occur when patients who initially had good success end up finding new ways to get around the smaller stomach. The surgeons and follow up staff will warn people about this, but in the end, it’s always up to the patient.

Post-Bariatric Surgery and Sleep Apnea

Studies have been done looking at the effects of bariatric surgery on sleep apnea. Most of the people on a waitlist for bariatric surgery who get tested for sleep apnea end up testing positive for sleep apnea (80% positive scores vs 20% negative for sleep apnea). If anything, if someone you know is on a waitlist for bariatric surgery, and they have not been tested, it is a good idea to find out if they have it, as problems can arise in surgery.

Other studies have been done to show the effects of bariatric surgery on the severity of sleep apnea. First, many patients do feel much better. One year after surgery, the average body mass index (BMI – which is a crude determinant of healthy weight) has dropped from 51 (normal range 21-25), down to 32. For the average 5 foot 8 inch person, that is a loss of close to 120 pounds.  That is a success!

When we look at the average level of sleep apnea in patients on a waitlist for bariatric surgery, patients will have a severe degree of sleep apnea, obstructing 47 times per hour (normal range 0-5 events per hour). One year after successful surgery, their obstructive index has dropped from 47 events per hour to about 24 events per hour. That has dropped them by a level of severity, to moderate sleep apnea, but still sleep apnea nonetheless.

For those who use CPAP therapy before surgery, their average pressure was set at 11.5 cm of water. After surgery, their average CPAP pressure was set down to 8.4 cm of water. What this means is that it takes less pressure to support the collapsing airway, which makes sense when you lose weight.

There are some who lose enough weight to be able to no longer need CPAP therapy for control of their sleep apnea, but that is not the norm. If you know someone who has had bariatric surgery, they should be retested for sleep apnea afterwards (a year later), and make sure if they are deciding to get rid of CPAP, that they understand the remaining risks, if any.

Sources:

Lettieri CJ; et al. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med 2008;4(4):333-338.

Khan A; et al. Assessment of obstructive sleep apnea in adults undergoing bariatric surgery in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. J Clin Sleep Med 2013;9(1):21-29.

 
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