Weight-Loss Surgery Offers Long-Term Relief For Obese Patients Affected With Sleep Apnea Syndrome

Washington, DC - September 24, 2000

Sleep apnea patients with morbid obesity may find bariatric surgery the optimum treatment for this deadly sleep disorder.

The normal standard of treatment for sleep apnea has been cold-steel surgery (UPPP), laser surgery (LAUP) or radiofrequency reduction of the soft palate. However, a new study reveals that for the morbidly obese, bariatric surgery may be the best solution. The surgical intervention for control of obesity and its allied diseases leads to a loss of weight which may alleviate the disorder.

It is estimated that more than one percent of all adult men are affected by sleep apnea syndrome (SAS), which is defined as repeated episodes of obstructive apnea and hypopnea (breathing that is shallower or slower than normal) during sleep. The disorder, which is 25 times more likely to occur in the morbidly obese, may cause patients to have an increased susceptibility to cardiovascular complications such as hypertension, cardiac arrhythmias, stroke, and myocardial infarction.

The authors of the study, "Bariatric Surgery for Treatment of Sleep Apnea Syndrome," are Michael Scheuller, MD, of Dartmouth Medical School, and Dudley Weider, MD, of Dartmouth-Hitchcock Medical Center, both located in New Hampshire. Dr. Scheuller presented the findings on Sunday, September 24th, at the Annual Meeting of the American Academy of Otolaryngology -- Head and Neck Surgery Foundation, held at the Washington, DC Convention Center from September 24-27, 2000.

Although there are many surgical treatment methods for SAS, it is possible that bariatric surgery may be the most effective choice for morbidly obese patients. Thus, this research demonstrates a possible alternative to the current standard of care for treatment of SAS in morbidly obese patients.

Methodology

Eighteen patients, 11 men and 7 women with an average age of 37.6, who were referred for treatment of severe SAS, were chosen. The average preoperative weight of these patients was 341.8 pounds while their average postoperative weight was 218.8 pounds (average weight lost 122.9 pounds). All were diagnosed, treated, and followed for a period of 1-12 years in a private clinic in an academic tertiary referral center.

An extensive medical history was obtained for each patient regarding their snoring, observed apnea spells, and excessive daytime sleepiness. Sleep tests were performed on all patients and in some cases, a preliminary surgical procedure was advised. Diet therapy was always suggested. With the exception of one patient, none were able to lose enough weight to resolve the SAS symptoms; thus, bariatric surgery was suggested.

The surgical method, biliopancreatic bypass with two-thirds distal gastrectomy was used for the majority of patients. However, four received gastroplasty (a restructuring of the stomach), a less complex surgery with fewer complications.

Results

All 18 patients achieved a weight loss in excess of 60 pounds with improved sleep study results. Most patients who had undergone a bariatric procedure maintained a stable weight. Overall, the biliopancreatic bypass surgery provided the most weight loss; however, the gastroplasty procedure provided weight loss sufficient to cure SAS.

Other benefits were reported by patients beyond the resolution of SAS. They included the following: improved memory, ability to resume normal functions such as athletics, fewer accidents like stumbling and tripping, improved self-image, and financial savings for food expenditures.

Conclusions

Although there are other methods of treating SAS in the morbidly obese patient, these methods are unlikely to cure SAS unless significant weight loss occurs. When weight loss is achieved, the likelihood is excellent that SAS will greatly diminish or completely resolve, which provides for an enhanced quality of life. Bariatric surgery is one means of allowing substantial and long-term weight loss for morbidly obese patients. Thus, it is seen as an effective short and long-term treatment for SAS, and could be considered a new standard of care for this syndrome.