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printer-friendly version| Can Weight Loss Surgery Cure Sleep Apnea? by Tomasz Rogula, MD, PhD, and Philip Schauer, MD, FACS WHAT IS SLEEP APNEA? Obstructive sleep apnea is a chronic, serious medical condition that occurs when breathing stops. It usually happens many times at night, lasting for about 10 seconds each time. Most sufferers are unaware of the condition unless they are told they snore loudly. People with sleep apnea experience daytime sleepiness, irritability, and impaired mental and physical functioning. WHAT CAUSES SLEEP APNEA? Sleep apnea is caused by the back of the throat collapsing, thereby obstructing the airways. This type of apnea is called obstructive sleep apnea and often is seen in those who are obese. The condition will cause you to gasp and snore loudly in your sleep, but will not awaken you. Sleep apnea also can be caused by neurological problems resulting in a failed signal to the airway muscles to breathe (called central sleep apnea). Unlike obstructive sleep apnea, those suffering from this type of apnea usually are aware of the condition, as it wakes them up at night. Central sleep apnea is seen less frequently in those who are obese. Those who suffer from severe acid reflux (GERD) also may experience sleep apnea. In this condition, stomach acid enters the esophagus, producing a spasm of the vocal cord and blocking the flow of air to the lungs. GERD is more often seen in individuals who are obese. IS SLEEP APNEA DANGEROUS? Sleep apnea causes drowsiness and sleepiness, which significantly impairs performance at work and at home. Drowsy driving as the result of sleep apnea is the cause of many car accidents. Severe sleep apnea also leads to many serious health problems, including hypertension, stroke, heart failure and heart attack. Obese people with sleep apnea have an enhanced risk of heart problems. These conditions are linked to the obstruction of breath during apnea episodes and elevated carbon dioxide with decreased oxygen levels. Researchers also have found an association between diabetes and sleep apnea. Some individuals with long-standing apnea may develop pulmonary hypertension, glaucoma and irregular menstrual periods. Finally, daytime sleepiness and nighttime noisy snoring can bring emotional problems and depression, adversely affect the quality of sleep of an individual?s bed partner, and sometimes even disrupt relationships. IS SLEEP APNEA RELATED TO OBESITY? Obesity is strongly associated with sleep apnea and increases the risk of having this problem tenfold, from two to four percent in the general population to 20 to 40 percent in individuals who are obese (defined as having a body mass index greater than 30). The more the body weighs, the greater the amount of fat pressing down on the chest and lungs. Also, having a larger neck, particularly in men, increases the risk of having sleep apnea. Some individuals with a greater amount of fat around the abdomen (the so-called apple shape) also are prone to having apnea. Sleep apnea often is associated with metabolic syndrome, which is a combination of disorders related to obesity (diabetes, hypertension, hypercholesterolemia, etc.). Furthermore, those with sleep apnea are often too tired to exercise and therefore gain weight more easily. HOW DO I CHECK TO SEE IF I HAVE SLEEP APNEA? People who snore loudly, experience sleepiness during the day or have irregular breathing may need to be checked for sleep apnea. The Epworth Sleepiness Scale is a questionnaire to assess sleepiness during typical daily situations (sitting, watching TV, driving, etc.). This is a screening test, which indicates whether more profound testing is required. Polysomnography is a very accurate diagnostic test, which electronically monitors instances of apnea (stopped breathing), brain activity, heartbeats, oxygen level and many other parameters. Polysomnogram often requires overnight stay at a sleep center. HOW IS SLEEP APNEA TRADITIONALLY TREATED? Continuous positive airflow pressure (CPAP) therapy is considered a standard treatment of sleep apnea. It involves the use of a device to deliver low-pressure air to keep airways open during the night. The air pressure is individually determined during a sleep study, depending on the severity of sleep apnea. Some individuals may have difficulties using CPAP, particularly the mask, which can irritate the nose, eyes and throat. Some newer devices have the ability to customize the pressure, instead of delivering continuous air pressure. Bilevel systems (BiPAP) are helpful for those with coexisting lung diseases and very high levels of carbon dioxide. Auto-CPAP keeps the pressure low until an episode of apnea is detected, then increases it automatically. Surgery sometimes is recommended for select individuals with severe obstructive sleep apnea. The procedure, called uvulopalatopharyngoplasty, is performed by throat specialists and involves the removal of soft tissues on the back of the throat, palate and tonsils. It increases the throat?s opening and improves the soft palate. The average long-term success rate of this procedure is about 50 percent. IS WEIGHT-LOSS SURGERY EFFECTIVE IN TREATING SLEEP APNEA? It is very beneficial for individuals who are obese and suffer from obstructive sleep apnea to lose weight. By loosing only 10 percent of your body weight, you can decrease your risk of developing sleep apnea by 26 percent. Bariatric surgery has been proven to be the only effective method of long-term sustained weight loss for those who are morbidly obese (a BMI greater than 35 and serious obesity-related health problems, including sleep apnea). Roux-en-Y gastric bypass is the most common bariatric procedure, as it is a very powerful weight-loss tool and, therefore, an effective treatment for sleep apnea. Successful bariatric surgery is associated with the improvement or complete resolution of obstructive sleep apnea. Individuals having undergone the surgery note improvements in snoring and daytime sleepiness. The vast majority of individuals who had to use CPAP before surgery do not require it approximately six months after weight-loss procedures. Although other methods of treating obstructive sleep apnea in those who are morbidly obese are available, they are unlikely to serve as a cure, unless significant weight loss occurs. When weight loss is achieved, the likelihood is excellent that sleep apnea will greatly diminish or completely resolve, which provides for an enhanced quality of life. Bariatric surgery is seen as an effective short- and long-term treatment for obstructive sleep apnea, and should be considered a standard of care for individuals who are morbidly obese and suffer from this syndrome. IS IT SAFE FOR ME TO HAVE BARIATRIC SURGERY IF I HAVE SLEEP APNEA? Overall, the risk of complications from bariatric surgery is slightly higher for those who have sleep apnea. Individuals with obstructive sleep apnea who are candidates for bariatric operations should be carefully checked and diagnosed prior to surgery. Some anesthetic agents and narcotics used during the operation adversely affect the airway, worsening obstruction. However, the risk to individuals with sleep apnea of developing major complications from bariatric surgery is still very low (less than five percent), and the benefits far outweigh any potential risks.  Tomasz Rogula, MD, PhD, is a Staff Surgeon at the Bariatric and Metabolic Institute at Cleveland Clinic. He has trained in weight-loss surgery in the United States, Italy and France. In addition to bariatric surgery, his specialty interests include laparoscopic and robotic surgery, gastrointestinal surgery and hernia repair. Dr. Rogula has done pioneering research on novel weight-loss surgery procedures. He also has publishedmultiple articles and book chapters on the topics of bariatric and laparoscopic surgery.  Philip Schauer, MD, FACS, is the Director of Advanced Laparoscopic and Bariatric Surgery at Cleveland Clinic and president of the American Society for Bariatric Surgery. In addition to bariatric surgery, his specialty interests include laparoscopic surgery, gastrointestinal surgery and colon surgery. A frequent lecturer, Dr. Schauer also has published scores of articles on topics relating to bariatric and laparoscopic surgery, and his first textbook on this subject is due out in the summer of 2007. |
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