Advertisement

Obesity Surgery

, Volume 19, Issue 1, pp 74–79 | Cite as

Respiratory Sleep Disturbances in Patients Undergoing Gastric Bypass Surgery and Their Relation to Metabolic Syndrome

  • Neus SalordEmail author
  • Mercedes Mayos
  • Rosa Miralda
  • Antonio Perez
Research Article

Abstract

Background

The prevalence of obstructive sleep apnea syndrome (OSAS) is high in obese patients. Certain components of metabolic syndrome are linked to OSAS, but there is no information on their association in morbidly obese patients. Our aim was to ascertain the prevalence of respiratory disturbances during sleep in candidates for bariatric surgery and to study their association with metabolic syndrome.

Methods

We examined the preoperative records (history, physical examination and laboratory findings, spirometry, and overnight pulse oximetry [arterial oxygen saturation by pulse oximetry, [SpO2]]) of patients scheduled for gastric bypass surgery for 1 year in our hospital; an overnight sleep study was performed if SpO2 readings or symptoms suggested sleep disturbance. Metabolic syndrome was defined according to the criteria of the National Cholesterol Education Program’s Adult Treatment Panel III.

Results

Of the 31 patients studied, 19 (61.3%) had OSAS, including 15 newly diagnosed cases with a mean ± standard deviation apnea–hypopnea index of 49 ± 36. OSAS patients had higher fasting plasma glucose and triglyceride levels and a higher prevalence of diabetes. Metabolic syndrome was also more frequent in subjects with previously untreated OSAS (13/14, 92%) than in those without sleep disturbance (six of 11, 55%; p = 0.033). Conversely, the prevalence of OSAS in patients with metabolic syndrome was higher (13/19, 68%) than in subjects without metabolic syndrome (one of six, 17%; p = 0.026) even though the two groups had similar body mass index.

Conclusions

Sleep disordered breathing is very prevalent in obese patients who are candidates for bariatric surgery and its presence is related to metabolic syndrome.

Keywords

Gastric bypass Obesity Metabolic syndrome Obstructive sleep apnea syndrome 

Abbreviations

AHI

Apnea–hypopnea index

BMI

Body mass index

CPAP

Continuous positive airway pressure

FEV1

Forced expiratory volume in the first second

FVC

Forced vital capacity

HDL

High-density lipoprotein

LDL

Low-density lipoprotein

NCEP-ATP

National Cholesterol Education Program’s Adult Treatment Panel

OSAS

Obstructive sleep apnea–hypopnea syndrome

PaCO2

Partial pressure of carbon dioxide, arterial

PaO2

Partial pressure of oxygen, arterial

SpO2

Arterial oxygen saturation by pulse oximetry

TLC

Total lung capacity

VLDL

Very low-density lipoprotein

Notes

Acknowledgments

This work was supported by Spanish network for the study of respiratory diseases (CIBER) of the Carlos III Health Institute (CB06/06). M. E. Kerans assisted with the English expression in a version of the manuscript.

Conflict of interest statement

None of the authors have conflicts to disclose.

References

  1. 1.
    Mokkad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003;289:76–9.Google Scholar
  2. 2.
    Ferranini E, Natali A, Bell P, et al. Insulin resistance and hypersecretion in obesity. J Clin Invest 1997;100:1166–73.CrossRefGoogle Scholar
  3. 3.
    Lakka HM, Laksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle aged men. JAMA 2002;288:2709–16.CrossRefGoogle Scholar
  4. 4.
    Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. NIH publication No 98-4083. September 1998.Google Scholar
  5. 5.
    Young TB, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol 2005;99:1592–1499.Google Scholar
  6. 6.
    Young TB, Peppard P, Gottlied D. Epidemiology of obstructive sleep apnea. Am J Respir Crit Care 2002;165:1217–39.CrossRefGoogle Scholar
  7. 7.
    Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg 2003;13:674–85.CrossRefGoogle Scholar
  8. 8.
    O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg 2004;14:23–6.CrossRefGoogle Scholar
  9. 9.
    Partien M, Guilleminault C. Daytime sleepiness and vascular morbidity at seven year follow up in obstructive sleep apnea patients. Chest 1990;97:27–2.CrossRefGoogle Scholar
  10. 10.
    Nieto FJ, Young TB, Lind BK, et al. Association of seep disordered breathing, sleep apnea and hypertension in a large community-based study. JAMA 2000;283:1829–36.CrossRefGoogle Scholar
  11. 11.
    Young TB, Peppard PE. Sleep-disordered breathing and cardiovascular disease: epidemiologic evidence for a relationship. Sleep 2000;23 S 4:s122–6.PubMedGoogle Scholar
  12. 12.
    Ip MS, Lam B, Tang LC, et al. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 2002;165:670–6.CrossRefGoogle Scholar
  13. 13.
    Herder CD, Jshemech J, Appelboom DJK, et al. Risks of general anaesthesia in people with obstructive sleep apnoea. BMJ 2001;329:955–9.CrossRefGoogle Scholar
  14. 14.
    Kaw R, Michota F, Jaffer A, et al. Unrecognized sleep apnea in the surgical patient. Chest 2006;129:198–205.CrossRefGoogle Scholar
  15. 15.
    Gupta R, Parvizi J, Hanssen A, et al. Postoperative complications in patients undergoing hip or knee replacement. A case–control study. Mayo Clin Proc 2001;76:897–905.CrossRefGoogle Scholar
  16. 16.
    Rennotte M, Baele P, Aubert G, et al. Nasal continuous positive airway pressure in the perioperative management of patients with obstructive sleep apnea submitted to surgery. Chest 1996;107:367–74.CrossRefGoogle Scholar
  17. 17.
    Coughlin S, Mawdsley L, Mugarza J, et al. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004;25:735–41.CrossRefGoogle Scholar
  18. 18.
    Lee WJ, Huang MT, Wang W, et al. Effects of obesity surgery on the metabolic syndrome. Arch Surg 2004;139:1088–92.CrossRefGoogle Scholar
  19. 19.
    Rodríguez-Roisin R, Agustí A, Burgos F, et al. Grupo de Trabajo de la SEPAR para la práctica de la gasometría arterial. Arch Bronconeumol 1998;34:142–53.CrossRefGoogle Scholar
  20. 20.
    Roca J, Sanchis J, Agusti-Vidal A, et al. Spirometric reference values from a Mediterranean population. Bull Eur Physiopathol Respir 1986;22:217–24.PubMedGoogle Scholar
  21. 21.
    Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89.Google Scholar
  22. 22.
    Chiner E, Signes-Costa J, Arriero JM, et al. Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax 1999;54 11:968–71.CrossRefGoogle Scholar
  23. 23.
    Rechtschaffen A, Kales A. A manual of standardized terminology techniques and scoring systems for sleep stages of human subjects. Washington, DC: US-Government Printing Office; 1968.Google Scholar
  24. 24.
    EEG arousals. Scoring rules and examples: a preliminary report from the sleep disorders. Altas task force of the American Academy of Sleep Medicine. Sleep 1992;15:173–4.CrossRefGoogle Scholar
  25. 25.
    Grupo Español de Sueño. Consenso nacional sobre el síndrome de apneas–hipopneas del sueño. Arch Bronconeumol 2005;41:E4.Google Scholar
  26. 26.
    Burwell CS, Robin ED, Whaley RD, et al. Extreme obesity associated with alveolar hypoventilation: a Pickwickian syndrome. Am J Med 1956;21:811–8.CrossRefGoogle Scholar
  27. 27.
    The expert committee on the diagnosis of diabetes mellitus. Report of the committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20:1183–97.CrossRefGoogle Scholar
  28. 28.
    Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the third report of the national cholesterol education program (NCEP). Expert panel on detection evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486–97.CrossRefGoogle Scholar
  29. 29.
    Meoli AL, Rosen CL, Kristo D, et al. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period. Avoiding complications. Sleep 2003;8:1060–5.Google Scholar
  30. 30.
    Benumof J. Obstructive sleep apnea in the adult obese patient: implications for airway management. Anesthesiol Clin N Am 2002;20:789–811.CrossRefGoogle Scholar
  31. 31.
    Kaw R, Michota F, Jaffer A, et al. Unrecognized sleep apnea in the surgical patient. Implications for the perioperative setting. Chest 2006;129:198–205.CrossRefGoogle Scholar
  32. 32.
    Peppard PE, Young TB, Palta M, et al. Prospective study of the association between seep-disordered breathing and hypertension. New Eng J Med 2000;342:1378–84.CrossRefGoogle Scholar
  33. 33.
    Punjabi N, Shahar E, Redline S, et al. Sleep-disordered breathing, glucose intolerance and insulin resistance. The Sleep Heart Study. Am J Epidemil 2004;160:521–30.CrossRefGoogle Scholar
  34. 34.
    Punjabi N, Sorkin J, Katzel L, et al. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002;165:677–82.CrossRefGoogle Scholar
  35. 35.
    Meslier M, Gagnadoux F, Giraud P, et al. Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 2003;22:156–60.CrossRefGoogle Scholar
  36. 36.
    Vgontzas AN, Bixler BO, Chrousos GP. Sleep apnea is a manifestation of the metabolic syndrome. Sleep Med Rev 2005;9 3:211–24.CrossRefGoogle Scholar
  37. 37.
    Wilcox I, McNamara SG, Collins FL, et al. “Syndrome Z”: the interaction of sleep apnoea, vascular risk factors and the heart disease. Thorax 1998;53:S25–8.CrossRefGoogle Scholar
  38. 38.
    Phillips BG, Hisel TM, Kato M, et al. Recent Weight gain in patients with newly diagnosed obstructive sleep apnea. J Hypertens 1999;17:1297–300.CrossRefGoogle Scholar
  39. 39.
    NarKiewicz K, Somers VK. Sympathetic nerve activity in obstructive sleep apnoea. Acta Physiol Scand 2003;177:285–390.CrossRefGoogle Scholar
  40. 40.
    Leuenberger U, Jacob E, Sweer L, et al. Surges of muscle sympathetic nerve activity during obstructive sleep apnea are linked to hypoxemia. J Appl Physiol 1995;79:581–8.CrossRefGoogle Scholar
  41. 41.
    Bratel T, Wennlud A, Carlstrom K. Pituitary reactivity, androgens and catecholamines in obstructive sleep apnoea. Effects of continuous positive airway pressure treatment (CPAP). Respir Med 1999;93:1–7.CrossRefGoogle Scholar
  42. 42.
    Vgontzas AN, Papanicolau DA, Bixler BO, et al. Sleep apnea and daytime sleepiness and fatigue relation to visceral obesity, insulin resistance and hypercytokinemia. J Clin Endocrinol Metab 2000;85:1151–8.CrossRefGoogle Scholar
  43. 43.
    Phillips BG, Kato M, Narkiewicz K, et al. Increases in leptin levels, sympathetic drive and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol 2000;279:H234–7.CrossRefGoogle Scholar
  44. 44.
    Yokoe T, Minoguchi K, Matsuo H, et al. Elevated levels of C-reactive protein and interleukin -6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous pressure. Circulation 2003;107:1129–34.CrossRefGoogle Scholar
  45. 45.
    Harsh I, Schahin S, Radespel-Tröger M, et al. Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with obstructive sleep apnea syndrome. Am J Repir Crti Care Med 2004;162:156–62.CrossRefGoogle Scholar
  46. 46.
    Ip M, Lam K, Ho C, et al. Serun leptin and vascular risk factors in obstructive sleep apnea. Chest 2000;118:580–6.CrossRefGoogle Scholar
  47. 47.
    Viner S, Szalai J, Hofftein V, et al. Are history and physical examination a good screening test for sleep apnea? Ann Intern Med 1991;115:356–9.CrossRefGoogle Scholar
  48. 48.
    Serafini FM, Macdowell AW, Rosemurgy AS, et al. Clinical predictors of sleep apnea patients undergoing bariatric surgery. Obes Surg 2001;11:28–31.CrossRefGoogle Scholar
  49. 49.
    Dixon JB, Schanchter LM, O’Brien PE. Predicting sleep apnea and excessive sleepiness in the severely obese patients. Chest 2003;123:1134–41.CrossRefGoogle Scholar
  50. 50.
    Gylay S, Olson LG, Hensley MJ, et al. A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea. Am Rev Respir Dis 1993;147:50–3.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Neus Salord
    • 1
    Email author
  • Mercedes Mayos
    • 1
  • Rosa Miralda
    • 1
  • Antonio Perez
    • 2
  1. 1.Department of PneumologyHospital de la Santa Creu i Sant PauBarcelonaSpain
  2. 2.Department of EndocrinologyHospital de la Santa Creu i Sant PauBarcelonaSpain

Personalised recommendations