Ali Nihat ANNAKKAYA, Ege GÜLEÇ BALBAY, Mevlüt PEHLİVAN, Öner BALBAY

Obezite Cerrahisi Hastalarında Obstrüktif Uyku Apne Sıklığı

Amaç: Obezite, obstrüktif uyku apnesinin (OUA) en önemli risk faktörlerinden ve sonuçlarından biridir. Kilo verme ve pozitif hava yolu basıncı tedavisi OUA tedavisinde başlıca yaklaşımlardır. Bu çalışmada bariatrik cerrahi planlanan obezite hastalarında OUA prevalansının değerlendirilmesi amaçlandı. Yöntemler: Üniversite Hastanesi Obezite Merkezi'nde 2015 yılında bariatrik cerrahi adayı ardışık 141 hasta, uyku ile ilişkili solunum bozuklukları açısından ameliyat öncesi klinik olarak değerlendirildi. Tüm olgulara ameliyat öncesi polisomnografik inceleme önerildi. Bulgular: Yaş ortalaması 37±10 olan 141 obezite cerrahisi adayının 103'ü (%73) kadındı. Olguların ortalama vücut kitle indeksi 46,9±6,4 kg/m2 idi. OUA'nın majör semptomları değerlendirildiğinde; 119 (%84,4) hastada horlama, 63 (%44,7) hastada gündüz uyku hali ve 49 (%34,8) hastada tanıklı apne vardı. Polisomnografik değerlendirmeyi kabul eden hastaların %75,7 'sinde (84/111) AHİ>5/saat bulunması nedeniyle OUA saptandı. Polisomnografi yapılan olguların %24,3'ünde (27/111) OUA negatifdi, %29,7'sinde (33/111) hafif OSA, %17,1'inde (19/111) orta derecede OUA ve %28,8'inde (32/111) şiddetli OUA saptandı. AHİ ile yaş (p=0.003), boyun ve bel çapı (p<0.001) arasında pozitif, zorlu vital kapasite yüzdesi arasında negatif korelasyon (p<0.001) bulundu. Obezite cerrahisinden ortalama 9 ay sonra yapılan polisomnografik kontrollerde AHİ'de ortalama %41,2 iyileşme, VKİ'de ortalama %22,8 azalma gözlendi. Sonuç: Obezite cerrahisi adaylarında OUA prevalansı oldukça yüksek bulunmuştur. Obezite cerrahisi öncesi sadece semptomatik olgularda değil tüm olgularda polisomnografik inceleme yapılması gerektiği düşünülmektedir. Bariatrik cerrahi OSA'yı iyileştirmeye yardımcı olabilir.

Anahtar Kelimeler:

obezite, bariatrik cerrahi, uyku apne, CPAP tedavisi, laparoskopik sleeve gastrektomi

The Prevalence of Obstructive Sleep Apnea in Bariatric Surgery Patients

Objective: Obesity is one of the most important risk factors and also consequences of obstructive sleep apnea (OSA). Weight loss and positive airway pressure therapy are the main approaches in the treatment of OSA. In this study, it was aimed to evaluate the prevalence of OSA in obesity patients scheduled for bariatric surgery. Methods: In the University Hospital Obesity Center, 141 consecutive patients who were candidates for bariatric surgery in 2015 were clinically evaluated preoperatively for sleep-related respiratory disorders. Preoperative polysomnographic examination was recommended to all cases. Results: Of 141 bariatric surgery candidates with a mean age of 37±10 years, and 103 (73%) were female. The mean body mass index of the cases was 46.9±6.4 kg/m2. Among the major symptoms of OSA, snoring was present in 119 (84.4%), daytime sleepiness in 63 (44.7%) and witnessed apnea in 49 (34.8%) patients. OSA was detected because AHI>5/hour was found in 75.7% (84/111) of the patients who accepted the polysomnographic evaluation. 24.3% (27/111) of the cases who underwent polysomnography had non OSA, 29.7% (33/111) mild OSA, 17.1% (19/111) moderate OSA, and 28.8% (32 /111), severe OSA was detected. AHI was positively correlated with age (p=0.003), neck and waist diameter (p<0.001), and negatively correlated with percent of the forced vital capacity (p<0.001). In polysomnographic controls performed an average of 9 months after bariatric surgery, an average of 41.2% improvement in AHI was observed, compared to an average of 22.8% decrease in BMI. Conclusion: OSA prevalence was found to be very high in bariatric surgery candidates. It was thought that polysomnographic examination should be performed before bariatric surgery not only in symptomatic cases but also in all cases. Bariatric surgery can help improve OSA.

Keywords:

obesity, bariatric surgery, sleep apnea, CPAP therapy, laparoscopic sleeve gastrectomy,

PDF

___

1. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2009;7(8):687-98.
2. Kuvat N, Tanriverdi H, Armutcu F. The relationship between obstructive sleep apnea syndrome and obesity: A new perspective on the pathogenesis in terms of organ crosstalk. Clin Respir J. 2020;14(7):595-604.
3. Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL. Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc. 2002; 5(2):185-92.
4. Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and Risks of Bariatric Surgery in Adults: A Review. JAMA. 2020; 324(9):879-87.
5. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386:964-73.
6. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357:753-61.
7. Eckel RH. Clinical practice. Nonsurgical management of obesity in adults. N Engl J. Med. 2008;358:1941-50. 8. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 357:753-61.
9. Carlsson LM, Peltonen M, Ahlin S, Anveden A, Bouchard C, Carlsson B, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367:695-704.
10. Kwok CS, Pradhan A, Khan MA, Anderson SG, Keavney BD, Myint PK, et al Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol. 2014;173:20-8.
11. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. American academy of sleep medicine. Rules for scoring respiratory events in sleep: Update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American academy of sleep medicine. J Clin Sleep Med. 2012;8:597-619.
12. O'Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004;14:23-6.
13. Priyadarshini P, Singh VP, Aggarwal S, Garg H, Sinha S, Guleria R. Impact of bariatric surgery on obstructive sleep apnoea-hypopnea syndrome in morbidly obese patients. J Minim Access Surg. 2017;13(4):291-5.
14. Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, et al .Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009;32:1017-19.
15. Stenberg E, Dos Reis Falcão LF, O'Kane M, Liem R, Pournaras DJ, et al .Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update. World J Surg. 2022; 46(4):729-51.
16. Haines KL, Nelson LG, Gonzalez R, Torrella T, Martin T, Kandil A, et al. Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea. Surgery. 20017;141:354-58.
17. Varela JE, Hinojosa MW, Nguyen NT. Resolution of obstructive sleep apnea after laparoscopic gastric bypass. Obes Surg. 2007;17:1279-82.
18. Fritscher LG, Mottin CC, Canani S, Chatkin JM. Obesity and obstructive sleep apnea-hypopnea syndrome: The impact of bariatric surgery. Obes Surg. 2007;17:95-9.
19. Sarkhosh K, Switzer NJ, El-Hadi M, Birch DW, Shi X, Karmali S. The impact of bariatric surgery on obstructive sleep apnea: A systematic review. Obes Surg. 2013; 23:414-23.
20. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: A systematic review and meta-analysis. JAMA. 2004; 292:1724-37.
21. Kopp HP, Kopp CW, Festa A, Krzyzanowska K, Kriwanek S, Minar E, et al. Impact of weight loss on inflammatory proteins and their association with the insulin resistance syndrome in morbidly obese patients. Arterioscler Thromb Vasc Biol. 2003;23:1042-47.
22. Pallayova M, Steele KE, Magnuson TH, Schweitzer MA, Smith PL, Patil SP, et al Sleep apnea determines soluble TNF-a receptor 2 response to massive weight loss. Obes Surg. 2011;21:1413-23.
23. Ashrafian H, Bueter M, Ahmed K, Suliman A, Bloom SR, Darzi A, et al. Metabolic surgery: An evolution through bariatric animal models. Obes Rev 2010;11:907-20.
24. Ashrafian H, le Roux CW, Rowland SP, Ali M, Cummin AR, Darzi A, et al. Metabolic surgery and obstructive sleep apnoea: The protective effects of bariatric procedures. Thorax. 2012;67:442-49.
25. Quintas-Neves M, Pretoa J, Drummonda M. Assessment of bariatric surgery efficacy on Obstructive Sleep Apnea (OSA) Rev Port Pneumol 2016;22(6):331-36
26. Cowan DC, Livingston E. Obstructive sleep apnoea syndrome and weight loss: review. Sleep Disord. 2012:163296.
27. Feigel-Guiller B, Drui D, Dimet J, Zair Y, Le Bras M, Fuertes Zamorano N, et al. Laparoscopic gastric banding in obese patients with sleep apnea: a 3-year controlled study and follow up after 10 years. Obes Surg. 2015; 25:1886-92.

ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez