Obesity related sleep apnea & weight loss surgery
Apneic episodes cause daytime sleepiness, hypertension, and increased risk of stroke, coronary artery disease and congestive heart failure
Post by DR. ATUL NC PETERS on Sunday, October 30, 2022
While the treatment for Obstructive Sleep Apnea (OSA) is not confined to any single strategy but requires a multidisciplinary approach, weight loss surgeries do play a major role. Being the most common type of breathing problem associated with obesity, the mainstay of treatment known as CPAP or BiPAP therapy remains the latest, most advanced and effective treatment modality in such people with OSA.
Morbidly obese patients have too much fat around the neck and throat area chocking out, leading to shallow breathing when in deep sleep. Sometimes in deep sleep patients tend to stop breathing altogether which is called apnea. These apnic spells occur every night and vary with different individuals. With worsening of the condition, this mechanism tends to happen even in the daytime also.
Apneic episodes cause daytime sleepiness, hypertension, and increased risk of stroke, coronary artery disease and congestive heart failure. Since obesity is a major risk factor for development of OSA, research has repeatedly confirmed that weight loss results not only in improvement of obstructive sleep apnoea in most of the patients, but also eliminates the risk for heart disorders and metabolic consequences related to both OSA and obesity.
Clinically it is seen that even moderate OSA can lead to cardiovascular complications of hypertension, cardiac arrhythmias, increased risk of stroke, coronary artery disease and congestive heart failure. Therefore, diagnostic sleep testing with polysomnography must be repeated when a goal weight or stable weight is attained after gastric bypass surgery, as only follow-up polysomnography can identify patients who have achieved resolution of OSA.
Bariatric or Gastric Bypass surgery is an effective treatment of severe or complicated obesity, and improves dramatically the cardiovascular risk factors and metabolic markers in majority. It has been demonstrated that patients experiencing the benefits of surgery-induced weight loss like improved mobility, stamina, cardiovascular status, diabetes, may feel well and believe that their OSA is cured. It is advised not to stop using CPap or Bi Pap machine after undergoing gastric bypass surgery even if one is feeling good and feel that you do not need then any longer.
(The Author is Director, Department of Bariatric, Minimal Access and General Surgery, Max Hospital Saket, New Delhi)