Probably too much to promise, but yet another benefit of the weight reduction that comes from Bariatric surgery. This speaks to another common issue - Obstructive Sleep Apnea (OSA).
I know you are aware of this diagnosis, presentation, and likely even the consequences of untreated OSA on various organ systems. We are seeing a slightly larger percentage of patients coming to us as new patients, who have been already worked up or diagnosed with Sleep Apnea. However, There still are a large number of patients we need to send for Pulmonary evaluation, and /or a sleep study (polysomnography) prior to surgery to suspected long term OSA.
I thought it would be nice to briefly review it here, and tie in the applications to weight, surgery, and preparation for surgery.
OSA is present in a significant number of middle aged adults, but much more common in our overweight population. Risk factors do include obesity, as well as the physical presence of a short and thick neck, as well as a small recessed jaw.
Roughly 70% of patients with OSA are obese. Similarly, the prevalence of OSA in obese men and women is estimated at 40%. For every increase in BMI by 6, OSA risk increases by 4x.
Symptoms are usually related to loud snoring, excessive daytime somnolence, and possibly witnessed apneic spells as reporter by a sleeping partner. Often the sleeping partner will present with the patient to report on his /her sleep disruption caused by the offending snoozer.
Disease states that have been associated with untreated OSA include heart failure, HTN, pulmonary HTN, MI, Cerebrovascular disease, chronic CAD, stroke and TIAs.
When we suspect OSA based on presentation, we will schedule a Pulmonary eval, and then a Sleep Study (polysonography) may be appointed for formal testing. Some insurance companies have recently adopted a policy of starting with a home screening sleep study, involving oximetry, which is not as sensitive a test but certainly less expensive. However, a negative home test does not rule out OSA.
Once a positive test is noted, there may be further studies with an appliance (BiPap, CPap) for comparison, and eventual titration.
From the Bariatric Surgery perspective, OSA for us is surrounded by a number of issues:
1. Preoperatively, we need to screen patients when necessary to appropriately prepare them for surgery, anesthesia, and post op narcotics that may cause increased risk of hypopnea and hypoxia if not identified.
2. Due to the referral process and the testing and retesting that may be required with Pulmonology, as well as obtaining and using a new appliance, time is of the essence! A patient may be ready for the OR otherwise, but occasionally end up due to an incomplete Pulmonary evaluation. Having a patient already appropriately diagnosed, or at least evaluated for OSA could greatly expedite their preoperative process.
3. And now the good news - A great proportion of patients that lose weight after Bariatric Surgery do in fact see significant improvement, or even resolution of their OSA. It is thought that this result is secondary to reduction of adipose tissue in the parapharyngeal tissues. Patients who primarily have a fixed structural etiology to their OSA (soft palate, uvula, peripharygeal tissues, tonsils, mandibular structure) may not see the same improvement, but his subset of patients is less common than the former. For some, a uvulopaltopharyngoplasty or jaw surgery may be required.
So... the next time a couple comes in to complain about some snoring in the bedroom, don't be too quick to reach for the Viagra. Notice the BMI of the offending snoozer, and consider it an opportunity to review other comorbidites that together may make a compelling case for weight loss surgery!
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