HJAR Nov/Dec 2022

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2022 53 Samuel Bledsoe, MD, FACS, FASMBS Bariatric and Metabolic Institute Arkansas Heart Hospital weight gain. Obesity increases the fatty de- posits in the neck and throat causing these tissues to obstruct and narrow the airway during sleep. People suffering fromOSAof- ten snore due to the airway obstruction and suffer from excessive sleepiness during the daytime due to poor sleep at night. Historically, continuous positive airway pressure (CPAP) was considered the most re- liable treatment for OSA. With CPAP, a mask fits over the mouth and nose while air blows into the upper airway preventing a collapse of the tissues. Unfortunately, less than 50% of patients use the CPAP nightly, because the mask can be uncomfortable and cumber- some. And CPAP does not provide a cure for sleep apnea, but a means of treating the con- ditionmaking its symptoms easier to control. Fortunately for patients who suffer from both sleep apnea and obesity, the significant weight loss that occurs with bariatric surgery can result in complete or partial resolution of OSA. For example, the Swiss Multicenter Bypass or Sleeve Study (SM-BOSS) is a pro- spective, randomized trial of 217 patients. They performed either a laparoscopic sleeve gastrectomy (LSG) or a laparoscopic Roux- en-YU gastric bypass (LRYGB) and followed the results over five years. At three years, both groups had lost more than 70% of their ex- cess body weight, and all of them reported remission or improvements in their OSA. 1 At five years, over 95% of patients still reported remission or improvement of their OSA. 2 An- other 2013 systematic review looked at 69 studies that included nearly 14,000 patients. The authors noted that “over 75% of patients saw at least an improvement in their sleep apnea.” 3 These results are backed up in my own practice at Arkansas Heart Hospital’s Bar- iatric & Metabolic Institute. We have hun- dreds of patients who resolved their OSA and have been able to put their CPAP in the closet. Many hundreds more had significant improvements in their disease. The remis- sion and improvement of OSA results in an improved quality of life by providing a more restful sleep at night and decreased daytime sleepiness and is a contributing factor for extended life expectancy in bariatric surgery patients, adding between five to 10 years! It is no wonder that more and more patients suffering with OSA are looking to bariatric surgery to improve their health and qual- ity of life. n REFERENCES 1 Peterli, R.; Wölnerhanssen, B.K.; Vetter, D.; et al. “Laparoscopic Sleeve Gastrectomy Versus Roux- Y-Gastric Bypass for Morbid Obesity-3-Year Out- comes of the Prospective Randomized Swiss Multicenter Bypass Or Sleeve Study (SM-BOSS).” Annals of Surgery 265, no. 3 (March 2017):466- 473. doi: 10.1097/SLA.0000000000001929 2 Peterli, R.; Wölnerhanssen, B.K.; Peters, T.; et al. “Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial.” JAMA 319, no. 3 (Jan. 16, 2018:255-265. doi: 10.1001/ jama.2017.20897 3 Sarkhosh, K.; Switzer, N.J.; El-Hadi, M.; et al. “The impact of bariatric surgery on obstructive sleep apnea: a systematic review.” Obesity Surgery 23, no. 3 (March 2013): 414-23. doi: 10.1007/s11695-012- 0862-2 QUALITY sleep is something that we all need as it plays an important role in our overall health and well-being. Adequate and restful sleep has been linked to improved memo- ry, better immune function, maintaining a healthy weight, improvements in cardiovas- cular health, mood stability, and even staving off the ravages of dementia. But most of us do not get enough sleep at night — neither in quality nor quantity. This could be due to our personal behaviors, or due to underly- ing disease. The Centers for Disease Control and Pre- vention (CDC) estimates that as many as 70 millionAmericans suffer from some type of sleep related disorder. The most common of these disorders is obstructive sleep ap- nea (OSA), which affects approximately 1 in 12 Americans. OSA is characterized by tem- porary pauses in breathing while sleeping, which then result in decreased oxygen levels in the blood. These pauses can last from a few seconds to a minute or longer and can occur anywhere from a few times to 30 or more times per hour. Left untreated, OSAcan lead to high blood pressure and cardiac ar- rhythmias, and in extreme cases, even strokes and heart attacks. OSA and obesity have a strong connec- tion. As many as 80% of patients with OSA are also considered obese. The incidence of OSA is up to 30 times greater in the presence of severe obesity compared to a person of normal weight. This correlation is due to the anatomical changes that occur as a result of “Sleep is a time of intense neurological activity — a rich time of renewal, memory consolidation, brain and neurochemical cleansing, and cognitive maintenance. Properly appraised, our sleeping time is as valuable a commodity as the time we are awake. In fact, getting the right amount of sleep enhances the quality of every minute we spend with our eyes open.” —The Sleep Revolution by Arianna Huffington