Obstructive sleep apnea (OSA) is characterized by intermittent cessation or reduction of respiratory airflow, which reduces alveolar aeration and respiratory failure, resulting in pulmonary hypertension. Obesity is one of the most important causes of obstructive sleep apnea. People who are obese have thicker tissue around their throats that may predispose them to apnea. During apnea, the muscles of the diaphragm and chest work harder to open a closed airway, and as a result, many changes in blood pressure may occur. Breathing is usually resumed by gasping or shaking the body, which can reduce the quality of sleep and reduce the flow of oxygen to vital organs.
Untreated sleep apnea is associated with an increased risk of high blood pressure, irregular heartbeat, heart attacks and stroke. About 85% of people with sleep apnea are obese. Sleep apnea occurs in about 25% of men and about 10% of women. The disease can affect people of any age, but is more common in people over 40 and overweight. “Sleep apnea is a serious sleep disorder that, if left untreated, increases the risk of heart attack and stroke,” says Charles B., a physician at the Sleep Disorders Center of Cleveland Clinic. CPAP is an effective treatment for sleep apnea, but not all patients can use CPAP for a variety of reasons. “If you are obese and have sleep apnea, weight loss with obesity surgery can significantly improve your sleep apnea and may even allow you to stop using your CPAP.”
After diagnosing sleep apnea, treatment should begin by studying sleep at night. Sleep apnea needs treatment to prevent long-term complications such as high blood pressure, stroke, arrhythmia, cardiomyopathy (enlarged heart muscle tissue), congestive heart failure, diabetes and heart attacks. In addition, its treatment may help improve your quality of life by improving concentration and increasing energy levels. As a result, treating sleep apnea may help reduce occupational disorders, work-related accidents, and motor vehicle crashes.
Continues positive airway pressure (CPAP) is the preferred primary treatment for most people with obstructive sleep apnea. With CPAP, patients wear a mask (above the nose and / or mouth) that attaches to an air blower and pushes air through the nose and / or mouth.
CPAP prevents airway closure during its use, but does not cure sleep apnea, and apnea episodes return when CPAP is stopped or misused. Other types of airway positive pressure devices are available for people with CPAP intolerance. One of the problems with CPAP treatment is that it is difficult for patients to tolerate, so that less than 50% of patients actually wear a mask and use the device regularly. When used properly, CPAP is very effective in treating sleep apnea, but if the patient does not use CPAP, the risk of untreated sleep apnea-related conditions such as high blood pressure, irregular heartbeat, heart attacks and stroke remains high.
Obesity surgery is the most effective treatment for obstructive sleep apnea, which can be improved in 80 to 85% of cases. CPAP is helpful in some patients with severe sleep apnea, but it does not completely relieve sleep apnea. CPAP is an effective treatment for sleep apnea, but it does not cure sleep apnea. Surgical weight loss can be a lasting solution for sleep apnea. After surgery, patients usually notice a significant improvement in their sleep apnea symptoms – less snoring (if CPAP is not used) and less daytime sleepiness – in the first trimester. Up to one year after surgery, about 80 to 85 percent of sleep apnea patients experience improvement and can be separated from CPAP.
Obese patients have more adipose tissue in their upper airways. When they fall asleep, the muscles of the body, including the throat, become relax and the weight around the soft tissue closes part of the upper airways, partially or completely. After surgery, reducing the surrounding fat allows the airway to open, which eliminates sleep apnea. Elimination of sleep apnea is associated with improved upper airway passage associated with weight loss and reduction of upper airway adipose tissue. Reducing visceral fat improves diaphragmatic circulation and improves ventilation and oxygenation. Patients with sleep apnea and obesity have been shown to increase levels of proinflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Bariatric surgery reduces IL-6 and other systemic inflammatory markers, while increasing anti-inflammatory cytokines such as IL-8. The level of TNF-α 2 receptor decreases after obesity surgery, which is an independent predictor of sleep apnea improvement.
The positive effects of bariatric surgery on sleep apnea are evident in 3-6 months after surgery. For obese surgery patients, you may need to study your sleep if:
- Your partner has seen you stop breathing at night. They may say that you are snoring loudly.
- You snore at night and have high blood pressure, diabetes, heart disease or a stroke.
- You snore at night and feel extremely tired during the day.
- If your BMI is over 50.
- If your feet become swollen.
- If your doctor thinks you need a test.
We want to take all precautions to ensure your safety during bariatric surgery, and this includes examining sleep apnea. Before obesity surgery, it is recommended that polysomnography be performed to diagnose OSA and manage preoperative symptoms. Polysomnography is a type of sleep study and a multi-parameter test used in the study of sleep and as a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also called PSG for short. Studies show that patients with OSA who are diagnosed and treated before surgery are less likely to have serious cardiovascular complications such as cardiac arrest or shock. According to the latest studies, after bariatric surgery, the prevalence of OSA dropped from 71% initially to 44% in the 12 months postoperative. OSA was cured in 45% and improved in 78% of patients, but moderate to severe OSA still persisted in 20% of patients after surgery. As a result, bariatric surgery is considered as one of the most effective treatments for sleep apnea.