Sleeve gastrectomy improves obstructive sleep apnea syndrome (OSAS): 5 year longitudinal study

Background: Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obese patients. Evaluation of the specific effects of sleeve gastrectomy (SG) on upper airway function has not been reported. Given the possibility that some patients will not respond despite weight loss, no studies have investigated whether other mechanisms may be responsible for persistent OSAS after bariatric surgery. Objectives: To evaluate by subjective and objective assessment the impact of SG on upper respiratory physiology in the long-term. Setting: University Hospital, Division of Bariatric and ENT Surgery, in Italy. Methods: Thirty-six consecutive patients with OSAS who underwent laparoscopic SG were prospectively enrolled. The effect of SG on respiratory function and OSAS was followed for 5 years. Results: All patients completed the 5-year follow-up. A significant (P <.001) improvement in modified Epworth Sleepiness Scale questionnaire (ESS) was obtained in 91.6% (33/36) of patients. The Apnea/Hypopnea index (AM) improved in 80.6% (29/36) of patients after surgery (from 32.8 +/- 1.7 to 5.8 +/- 1.2 (P <.001), 4.9 +/- 1.7). The remaining 19.4% (7/36) of patients with a positive ESS and/or AHI all had an associated respiratory resistance due to nasal obstructive diseases. Conclusion: SG improved OSAS overall, but patients who did not improve or only partially improved despite weight loss were found to have an associated nasal responsible pathology. How these patients will respond to nasal surgery and whether a 2-step procedure should be recommended for OSAS patients requires further study. (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.