Skip to main content
SpringerLink
Log in

Sleep Apnea in the Bariatric Surgery Patient

  • Chapter
Minimally Invasive Bariatric Surgery

Abstract

Obstructive sleep apnea hypopnea (OSAH) is a chronic medical condition characterized by repetitive episodes of breathing disturbance, characterized by upper airway obstruction, occurring during sleep. It is extremely common in patients undergoing bariatric surgery and may impact perioperative complications. It is also one of the medical comorbidities of obesity that may be cured after the weight loss resulting from bariatric surgery. This chapter reviews the pathophysiology and clinical aspects of OSAH, emphasizing the relationship with obesity, bariatric preoperative workup and management, and the perioperative implications of OSAH.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 249.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 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;22:667–689.

    Google Scholar 

  2. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217–1239.

    Article  PubMed  Google Scholar 

  3. Young T, Shahar E, Nieto FJ, et al. Predictors of sleepdisordered breathing in community-dwelling adults: The Sleep Heart Health Study. Arch Intern Med 2002;162:893–900.

    Article  PubMed  Google Scholar 

  4. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–1235.

    Article  CAS  PubMed  Google Scholar 

  5. Perugini RA, Mason R, Czerniach DR, et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg 2003;138:541–545; discussion 545–546.

    Article  PubMed  Google Scholar 

  6. Fernandez AZ Jr, Demaria EJ, Tichansky DS, et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg 2004; 239:698–702; discussion 702–703.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000;232:515–529.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg 2004; 14:23–26.

    Article  PubMed  Google Scholar 

  9. Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg 2003;13:676–683.

    Article  PubMed  Google Scholar 

  10. Serafini FM, MacDowell Anderson W, Rosemurgy AS, Strait T, Murr MM. Clinical predictors of sleep apnea in patients undergoing bariatric surgery. Obes Surg 2001;11: 28–31.

    Article  CAS  PubMed  Google Scholar 

  11. Akashiba T, Kawahara S, Kosaka N, et al. Determinants of chronic hypercapnia in Japanese men with obstructive sleep apnea syndrome. Chest 2002;121:415–421.

    Article  PubMed  Google Scholar 

  12. Kessler R, Chaouat A, Schinkewitch P, et al. The obesityhypoventilation syndrome revisited: a prospective study of 34 consecutive cases. Chest 2001;120:369–376.

    Article  CAS  PubMed  Google Scholar 

  13. Kimoff RJ, Cosio MG, McGregor M. Clinical features and treatment of obstructive sleep apnea. Can Med Assoc J 1991;144:689–695.

    CAS  Google Scholar 

  14. Pressman MR, Figueroa WG, Kendrick-Mohamed J, Greenspon LW, Peterson DD. Nocturia. A rarely recognized symptom of sleep apnea and other occult sleep disorders. Arch Intern Med 1996;156:545–550.

    Article  CAS  PubMed  Google Scholar 

  15. Loh NK, Dinner DS, Foldvary N, Skobieranda F, Yew WW. Do patients with obstructive sleep apnea wake up with headaches? Arch Intern Med 1999;159:1765–1768.

    Article  CAS  PubMed  Google Scholar 

  16. Ohayon MM. The effects of breathing-related sleep disorders on mood disturbances in the general population. J Clin Psychiatry 2003;64:1195–1200; quiz, 1274–1276.

    Article  PubMed  Google Scholar 

  17. Gottlieb DJ, Whitney CW, Bonekat WH, et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med 1999;159: 502–507.

    Article  CAS  PubMed  Google Scholar 

  18. Foley D, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res 2004;56:497–502.

    Article  PubMed  Google Scholar 

  19. Vgontzas AN, Bixler EO, Tan T-L, Kantner D, Martin LF, Kales A. Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med 1998;158:1333–1337.

    Article  CAS  PubMed  Google Scholar 

  20. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 2000;85:1151–1158.

    Article  CAS  PubMed  Google Scholar 

  21. Dixon JB, Schachter LM, O’Brien PE. Sleep disturbance and obesity: changes following surgically induced weight loss. Arch Intern Med 2001;161:102–106.

    Article  CAS  PubMed  Google Scholar 

  22. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378–1384.

    Article  CAS  PubMed  Google Scholar 

  23. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001;163:19–25.

    Article  CAS  PubMed  Google Scholar 

  24. Resnick HE, Redline S, Shahar E, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care 2003;26:702–709.

    Article  PubMed  Google Scholar 

  25. Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002;165:677–682.

    Article  PubMed  Google Scholar 

  26. Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med 1999;340:847–851.

    Article  CAS  PubMed  Google Scholar 

  27. Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 2000;118:372–379.

    Article  CAS  PubMed  Google Scholar 

  28. Young T, Hutton R, Finn L, Badr S, Palta M. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 1996; 156:2445–2451.

    Article  CAS  PubMed  Google Scholar 

  29. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991;14:540–545.

    CAS  PubMed  Google Scholar 

  30. Dixon JB, O’Brien PE. Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Chest 2003;123:1134–1141.

    Article  PubMed  Google Scholar 

  31. Maislin G, Pack AI, Kribbs NB, et al. A survey screen for prediction of apnea. Sleep 1995;18:158–166.

    CAS  PubMed  Google Scholar 

  32. Chesson AL Jr, Berry RB, Pack A. Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. Sleep 2003; 26:907–913.

    PubMed  Google Scholar 

  33. Baltzan MA, Verschelden P, Al-Jahdali H, Olha AE, Kimoff RJ. Accuracy of oximetry with thermistor (OxiFlow) for diagnosis of obstructive sleep apnea and hypopnea. Sleep 2000;23:61–69.

    CAS  PubMed  Google Scholar 

  34. Schwab RJ, Gefter WB, Hoffman EA, Gupta KB, Pack AI. Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing. Am Rev Respir Dis 1993;148:1385–1400.

    Article  CAS  PubMed  Google Scholar 

  35. Reeves-Hoche MK, Hudgel DW, Meck R, Witteman R, Ross A, Zwillich CW. Continuous versus bilevel positive airway pressure for obstructive sleep apnea. Am J Respir Crit Care Med 1995;151:443–449.

    Article  CAS  PubMed  Google Scholar 

  36. Sanders MH, Kern N. Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Physiologic and clinical implications. Chest 1990;98:317–324.

    Article  CAS  PubMed  Google Scholar 

  37. Littner M, Hirshkowitz M, Davila D, et al. Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. An American Academy of Sleep Medicine report. Sleep 2002;25:143–147.

    PubMed  Google Scholar 

  38. Chervin RD, Theut S, Bassetti C, Aldrich MS. Compliance with nasal CPAP can be improved by simple interventions. Sleep 1997;20:284–289.

    CAS  PubMed  Google Scholar 

  39. Ferguson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA. A randomized crossover study of an oral appliance vs nasalcontinuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest 1996;109: 1269–1275.

    Article  CAS  PubMed  Google Scholar 

  40. Ferguson KA, Ono T, Lowe AA, al-Majed S, Love LL, Fleetham JA. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax 1997;52:362–368.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Liu Y, Lowe AA, Fleetham JA, Park YC. Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2001;120:639–647.

    Article  CAS  PubMed  Google Scholar 

  42. Larsson LH, Carlsson-Nordlander B, Svanborg E. Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome. Laryngoscope 1994;104:1362–1368.

    Article  CAS  PubMed  Google Scholar 

  43. Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996;19:156–177.

    CAS  PubMed  Google Scholar 

  44. Walker-Engstrom ML, Tegelberg A, Wilhelmsson B, Ringqvist I. 4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea: a randomized study. Chest 2002; 121:739–746.

    Article  PubMed  Google Scholar 

  45. Riley RW, Powell NB, Li KK, Troell RJ, Guilleminault C. Surgery and obstructive sleep apnea: long-term clinical outcomes. Otolaryngol Head Neck Surg 2000;122:415–421.

    CAS  PubMed  Google Scholar 

  46. Hochban W, Conradt R, Brandenburg U, Heitmann J, Peter JH. Surgical maxillofacial treatment of obstructive sleep apnea. Plast Reconstr Surg 1997;99:619–626; discussion 627–628.

    Article  CAS  PubMed  Google Scholar 

  47. Barbe F, Mayoralas LR, Duran J, et al. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness: a randomized, controlled trial. Ann Intern Med 2001;134:1015–1023.

    Article  CAS  PubMed  Google Scholar 

  48. Meyers JR, Lembeck L, O’Kane H, Baue AE. Changes in functional residual capacity of the lung after operation. Arch Surg 1975;110:576–583.

    Article  CAS  PubMed  Google Scholar 

  49. Siler JN, Rosenberg H, Mull TD, Kaplan JA, Bardin H, Marshall BE. Hypoxemia after upper abdominal surgery: comparison of venous admixture and ventilation-perfusion inequality components, using a digital computer. Ann Surg 1974;179:149–155.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. 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;26:1060–1065.

    PubMed  Google Scholar 

  51. Boushra NN. Anaesthetic management of patients with sleep apnoea syndrome. Can J Anaesth 1996;43:599-616.

    Google Scholar 

  52. Rosenberg J, Pedersen MH, Ramsing T, Kehlet H. Circadian variation in unexpected postoperative death. Br J Surg 1992;79:1300–1302.

    Article  CAS  PubMed  Google Scholar 

  53. Rosenberg-Adamsen S, Kehlet H, Dodds C, Rosenberg J. Postoperative sleep disturbances: mechanisms and clinical implications. Br J Anaesth 1996;76:552–559.

    Article  CAS  PubMed  Google Scholar 

  54. Rosenberg J, Wildschiodtz G, Pedersen MH, von Jessen F, Kehlet H. Late postoperative nocturnal episodic hypoxaemia and associated sleep pattern. Br J Anaesth 1994; 72:145–150.

    Article  CAS  PubMed  Google Scholar 

  55. Rennotte M, Baele P, Aubert G, Rodenstein D. Nasal continuous positive airway pressure in the perioperative management of patients with obstructive sleep apnea submitted to surgery. Chest 1995;107:367–374.

    Article  CAS  PubMed  Google Scholar 

  56. Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc 2001;76:897–905.

    Article  CAS  PubMed  Google Scholar 

  57. Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983;52: 490–494.

    Article  CAS  PubMed  Google Scholar 

  58. Roche F, Xuong AN, Court-Fortune I, et al. Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance. Pacing Clin Electrophysiol 2003;26:669–677.

    Article  PubMed  Google Scholar 

  59. Grimm W, Koehler U, Fus E, et al. Outcome of patients with sleep apnea-associated severe bradyarrhythmias after continuous positive airway pressure therapy. Am J Cardiol 2000;86:688–692.

    Article  CAS  PubMed  Google Scholar 

  60. Becker HF, Koehler U, Stammnitz A, Peter JH. Heart block in patients with sleep apnoea. Thorax 1998;53:29S–32.

    Article  Google Scholar 

  61. Harbison J, O’Reilly P, McNicholas WT. Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: effects of nasal continuous positive airway pressure therapy. Chest 2000;118:591–595.

    Article  CAS  PubMed  Google Scholar 

  62. Fichter J, Bauer D, Arampatzis S, Fries R, Heisel A, Sybrecht GW. Sleep-related breathing disorders are associated with ventricular arrhythmias in patients with an implantable cardioverter-defibrillator. Chest 2002;122:558–561.

    Article  PubMed  Google Scholar 

  63. Block M, Jacobson LB, Rabkin RA. Heart block in patients after bariatric surgery accompanying sleep apnea. Obes Surg 2001;11:627–630.

    Article  CAS  PubMed  Google Scholar 

  64. Fernandez AZ Jr, DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 2004;18:193–197. Epub 2003 Dec 29.

    Article  PubMed  Google Scholar 

  65. Livingston EH, Huerta S, Arthur D, Lee S, De Shields S, Heber D. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg 2002;236:576–582.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Cooney RN, Haluck RS, Ku J, et al. Analysis of cost outliers after gastric bypass surgery: what can we learn? Obes Surg 2003;13:29–36.

    Article  PubMed  Google Scholar 

  67. Fournier MR, Kerr PD, Shoenut JP, Yaffe CS. Effect of nasal continuous positive airway pressure on esophageal function. J Otolaryngol 1999;28:142–144.

    CAS  PubMed  Google Scholar 

  68. Huerta S, DeShields S, Shpiner R, et al. Safety and efficacy of postoperative continuous positive airway pressure to prevent pulmonary complications after Roux-en-Y gastric bypass. J Gastrointest Surg 2002;6:354–358.

    Article  PubMed  Google Scholar 

  69. Vasquez TL, Hoddinott K. A potential complication of bilevel positive airway pressure after gastric bypass surgery. Obes Surg 2004;14:282–284.

    Article  PubMed  Google Scholar 

  70. Victor DW Jr, Sarmiento CF, Yanta M, Halverson JD. Obstructive sleep apnea in the morbidly obese. An indication for gastric bypass. Arch Surg 1984;119:970–972.

    Article  PubMed  Google Scholar 

  71. Sugerman HJ, Fairman RP, Lindeman AK, Mathers JA, Greenfield LJ. Gastroplasty for respiratory insufficiency of obesity. Ann Surg 1981;193:677–685.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  72. Hamazoe R, Furumoto T, Kaibara N, Inoue Y Vertical banded gastroplasty for sleep apnea syndrome associated with morbid obesity. Obes Surg 1992;2:271–274.

    Article  PubMed  Google Scholar 

  73. Boone KA, Cullen JJ, Mason EE, Scott DH, Doherty C, Maher JW. Impact of vertical banded gastroplasty on respiratory insufficiency of severe obesity. Obes Surg 1996;6: 454–458.

    Article  PubMed  Google Scholar 

  74. Sugerman HJ, Fairman RP, Sood RK, Engle K, Wolfe L, Kellum JM. Long-term effects of gastric surgery for treating respiratory insufficiency of obesity. Am J Clin Nutr 1992;55:597S–601S.

    CAS  PubMed  Google Scholar 

  75. Charuzi I, Lavie P, Peiser J, Peled R. Bariatric surgery in morbidly obese sleep-apnea patients: short-and longterm follow-up. Am J Clin Nutr 1992;55:594S–596S.

    CAS  PubMed  Google Scholar 

  76. Pillar G, Peled R, Lavie P. Recurrence of sleep apnea without concomitant weight increase 7.5 years after weight reduction surgery. Chest 1994;106:1702–1704.

    Article  CAS  PubMed  Google Scholar 

  77. Dhabuwala A, Cannan RJ, Stubbs RS. Improvement in co-morbidities following weight loss from gastric bypass surgery. Obes Surg 2000;10:428–435.

    Article  CAS  PubMed  Google Scholar 

  78. Frigg A, Peterli R, Peters T, Ackermann C, Tondelli P. Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding. Obes Surg 2004;14:216–223.

    Article  PubMed  Google Scholar 

  79. Scheuller M, Weider D. Bariatric surgery for treatment of sleep apnea syndrome in 15 morbidly obese patients: longterm results. Otolaryngol Head Neck Surg 2001;125:299–302.

    Article  CAS  PubMed  Google Scholar 

  80. Rasheid S, Banasiak M, Gallagher SF, et al. Gastric bypass is an effective treatment for obstructive sleep apnea in patients with clinically significant obesity. Obes Surg 2003; 13:58–61.

    Article  PubMed  Google Scholar 

  81. Guardiano SA, Scott JA, Ware JC, Schechner SA. The longterm results of gastric bypass on indexes of sleep apnea. Chest 2003;124:1615–1619.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pulmonary, Allergy and Critical Care Medicine/Sleep Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA

    Rachel J. Givelber MD, FCCP, D, ABSM (Assistant Professor)

  2. Departments of Medicine and Anesthesiology, Division of Pulmonary, Allergy and Critical Care Medicine/Sleep Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA

    Mark H. Sanders MD, FCCP, D, ABSM (Professor)

Authors
  1. Rachel J. Givelber MD, FCCP, D, ABSM
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark H. Sanders MD, FCCP, D, ABSM
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Lerner College of Medicine, USA

    Philip R. Schauer MD (Professor of Surgery) (Professor of Surgery)

  2. Advanced Laparoscopic and Bariatric Surgery, Bariatric and Metabolic Institute The Cleveland Clinic Foundation, Cleveland, OH, 44195, USA

    Philip R. Schauer MD (Professor of Surgery) (Professor of Surgery)

  3. Department of Surgery Health Sciences Center, University of Virginia Health System, Charlottesville, VA, 22908, USA

    Bruce D. Schirmer MD (Stephen H. Watts Professor of Surgery) (Stephen H. Watts Professor of Surgery)

  4. Advanced Laparoscopic and Bariatric Surgery, Department of Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Stacy A. Brethauer MD (Staff Surgeon) (Staff Surgeon)

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Givelber, R.J., Sanders, M.H. (2007). Sleep Apnea in the Bariatric Surgery Patient. In: Schauer, P.R., Schirmer, B.D., Brethauer, S.A. (eds) Minimally Invasive Bariatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-68062-0_56

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-68062-0_56

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-68058-3

  • Online ISBN: 978-0-387-68062-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation