Gianmattia Del Genio1, Paolo Limongelli2, Federica Del Genio3, Gaetano Motta4, Ludovico Docimo2, Domenico Testa4. 1. Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy. Electronic address: gianmattia.delgenio@unina2.it. 2. Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy. 3. Center of Esophago-gastric and Bariatric Surgery, Clinica C.G. Ruesch, Naples, Italy. 4. Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology, Head and Neck Surgery Unit, Second University of Naples, Naples, Italy.
Abstract
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obese patients. Evaluation of the specific effects of sleeve gastrectomy (SG) on upper airway function has not been reported. Given the possibility that some patients will not respond despite weight loss, no studies have investigated whether other mechanisms may be responsible for persistent OSAS after bariatric surgery. OBJECTIVES: To evaluate by subjective and objective assessment the impact of SG on upper respiratory physiology in the long-term. SETTING: University Hospital, Division of Bariatric and ENT Surgery, in Italy. METHODS: Thirty-six consecutive patients with OSAS who underwent laparoscopic SG were prospectively enrolled. The effect of SG on respiratory function and OSAS was followed for 5 years. RESULTS: All patients completed the 5-year follow-up. A significant (P<.001) improvement in modified Epworth Sleepiness Scale questionnaire (ESS) was obtained in 91.6% (33/36) of patients. The Apnea/Hypopnea index (AHI) improved in 80.6% (29/36) of patients after surgery (from 32.8 ± 1.7 to 5.8 ± 1.2 (P<.001), 4.9 ± 1.7). The remaining 19.4% (7/36) of patients with a positive ESS and/or AHI all had an associated respiratory resistance due to nasal obstructive diseases. CONCLUSION: SG improved OSAS overall, but patients who did not improve or only partially improved despite weight loss were found to have an associated nasal responsible pathology. How these patients will respond to nasal surgery and whether a 2-step procedure should be recommended for OSAS patients requires further study.
BACKGROUND:Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obesepatients. Evaluation of the specific effects of sleeve gastrectomy (SG) on upper airway function has not been reported. Given the possibility that some patients will not respond despite weight loss, no studies have investigated whether other mechanisms may be responsible for persistent OSAS after bariatric surgery. OBJECTIVES: To evaluate by subjective and objective assessment the impact of SG on upper respiratory physiology in the long-term. SETTING: University Hospital, Division of Bariatric and ENT Surgery, in Italy. METHODS: Thirty-six consecutive patients with OSAS who underwent laparoscopic SG were prospectively enrolled. The effect of SG on respiratory function and OSAS was followed for 5 years. RESULTS: All patients completed the 5-year follow-up. A significant (P<.001) improvement in modified Epworth Sleepiness Scale questionnaire (ESS) was obtained in 91.6% (33/36) of patients. The Apnea/Hypopnea index (AHI) improved in 80.6% (29/36) of patients after surgery (from 32.8 ± 1.7 to 5.8 ± 1.2 (P<.001), 4.9 ± 1.7). The remaining 19.4% (7/36) of patients with a positive ESS and/or AHI all had an associated respiratory resistance due to nasal obstructive diseases. CONCLUSION: SG improved OSAS overall, but patients who did not improve or only partially improved despite weight loss were found to have an associated nasal responsible pathology. How these patients will respond to nasal surgery and whether a 2-step procedure should be recommended for OSAS patients requires further study.
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