If the cause of your obstructive sleep apnea relates to excessive weight, including morbid obesity, weight loss through bariatric surgery might be able to improve your sleep problem. But it is important to understand who qualifies for the procedure, the various surgical treatment options available and the potential risks and complications.
Do I Qualify for Bariatric Surgery?
Bariatric surgery describes procedures that are meant to change the structure of the upper gastrointestinal tract, most commonly the stomach and upper small intestine. It is often done in the morbidly obese to induce weight loss when diet and exercise regimens have failed.Individuals with obstructive sleep apnea (OSA) are candidates for bariatric surgery if they have a BMI greater than 35 kg/m2, which qualifies them as being morbidly obese. There should be no other major health problems that may make surgery dangerous. In addition, pregnancy should be avoided in the period following bariatric surgery, during which rapid weight loss may occur.
It is important to have a sleep study, called a polysomnogram, prior to your surgery to assess your particular risks. This will establish your baseline so as to better assess your response to treatment.
Types of Bariatric Surgery
There are multiple different types of bariatric surgery procedures. These options include:
- Vertical banded gastroplasty
- Adjustable gastric banding
- Roux-en-Y gastric bypass
In particular, the Roux-en-Y gastric bypass seems to deliver more sustainable weight loss. The type of procedure that may be most appropriate for your situation should be discussed with your surgeon.
What Are the Risks of Bariatric Surgery?
The risks of bariatric surgery include those that could occur with any surgery, including bleeding and infection. People undergoing this procedure are at higher risk of breathing problems, including during the period around the surgery. The surgery causes weight loss by restricting the number of calories that you take in. You may also be at risk for nutritional deficiencies as the ability to absorb nutrients will change. The risk of death with these procedures is less than 2 percent.
Does Bariatric Surgery Improve Sleep Apnea?
Many people who have bariatric surgery do show improvement in their OSA. However, it may be difficult to predict the degree of improvement that will occur.
It is important to continue using your continuous positive airway pressure (CPAP) around the time of surgery and in the period afterwards. As weight loss begins to occur, it is necessary to have your sleep reassessed with another sleep study after one to two years. This will determine if changes need to be made to your CPAP treatment pressure or even whether treatment is needed any longer.
The long-term results of bariatric surgery are mixed. In the first year, rapid weight loss occurs (typically 45 to 70 percent of excess body weight). This can improve the apnea-hypopnea index (AHI) and OSA. Despite even dramatic weight loss, after weight stabilizes most people remain obese and OSA may persist. Even with a stable weight after more than five years, these breathing abnormalities may persist or recur.
If you are interested in learning more about how bariatric surgery might improve your breathing during sleep, especially if you are overweight and have sleep apnea, you should speak with your doctor about the options available to you.
Sources:
Charuzi, I et al. "Bariatric surgery in morbidly obese sleep-apnea patients: Short- and long-term follow-up." Am J Clin Nutr 1992; 55:594S.
Johnson, W et al. "Surgical treatment of obesity." Curr Treat Options Gastroenterol 2006; 9:167.
NIH Consensus Development Conference Panel. "Gastrointestinal surgery for severe obesity." Ann Intern Med 1991; 115:956.
Pillar, G et al. "Recurrence of sleep apnea without concomitant weight increase 7.5 years after weight reduction surgery." Chest 1994; 106:1702.
Sugerman, H. "Clinical update: surgery for morbid obesity." Surgery 1993; 114:865.
Sugerman, H et al. "Long-term effects of gastric surgery for treating respiratory insufficiency of obesity." Am J Clin Nutr 1992; 55:597S.
