Highlights
- •Prevalence of obstructive sleep apnea (OSA) in adolescents undergoing metabolic bariatric surgery (MBS) is higher than the general adolescent population with severe obesity.
- •Adolescents whom have remission of OSA post-MBS have lower pre-MBS BMI and obstructive apnea hypopnea index (OAHI) compared to adolescents whom continue with OSA.
Abstract
Background
Little is known regarding obstructive sleep apnea’s (OSA’s) prevalence or the factors
related to OSA remission post–metabolic bariatric surgery (MBS) in adolescents.
Objectives
To identify the baseline OSA prevalence in adolescents with severe obesity and examine
factors associated with post-MBS OSA remission.
Setting
Tertiary-care children’s hospital.
Methods
We conducted a retrospective chart review of 81 patients pre-MBS with OSA assessments
done between June 2017 to September 2020 to collect demographic characteristics; co-morbidities;
polysomnography (PSG) results, if indicated; and weight data. Chi-square or Mann-Whitney
tests compared baseline characteristics and surgical outcomes by pre-MBS OSA status.
McNemar’s test or t tests assessed differences in baseline characteristics, stratified by remission versus
no remission of OSA.
Results
The patients were 71% female, had an average age of 16.9 ± 2.0 years, and had a mean
body mass index (BMI) of 47.9 ± 7.3 kg/m2. Half (50%) of the patients were Hispanic and 20% had type 2 diabetes. The OSA prevalence,
defined as an Obstructive Apnea Hypopnea Index (OAHI) score ≥5, was 54% pre-MBS (n
= 44), with 43% having severe OSA (OAHI > 30). Those with OSA were older (17.3 versus
16.4 yr, respectively; P = .05), more likely to be male (79% versus 42%, respectively; P = .022), and had higher baseline weights (142.0 versus 126.4 kg, respectively; P = .001) than those without OSA. Of the 23 patients with a post-MBS PSG result (average
5 mo post MBS), 15 (66%) had remission of OSA. Patients with OSA remission had a lower
average pre-MBS BMI (46.0 versus 57.7 kg/m2, respectively; P < .001) and weight (132.9 versus 172.6 kg, respectively; P = .002) but no significant differences in percentage weight loss through 12 months
post MBS versus those with continued OSA.
Conclusion
The OSA prevalence in an adolescent MBS population was higher than that in the general
adolescent population with severe obesity. Remission of OSA was correlated with lower
pre-MBS BMI and weight, but not weight loss within the first year post-MBS.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Surgery for Obesity and Related DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Predicting sleep apnea in morbidly obese adolescents undergoing bariatric surgery.Surg Endosc. 2014; 28: 1146-1152
- Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery.Am Surg. 2008; 74: 834-838
- Poor sleep and obesity: concurrent epidemics in adolescent youth.Front Endocrinol. 2018; 9: 364
- Metabolic consequences of obstructive sleep apnea in adolescents with obesity: a systematic literature review and meta-analysis.Child Obes. 2017; 13: 102-110
- The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood.Sleep. 2010; 33: 1447-1456
- Obstructive sleep apnea and the metabolic syndrome: the road to clinically-meaningful phenotyping, improved prognosis, and personalized treatment.Sleep Med Rev. 2018; 42: 211-219
- The relationship of hypertension with obesity and obstructive sleep apnea in adolescents.Pediatr Pulmonol. 2020; 55: 1020-1027
- Effects of surgical weight loss for treating obstructive sleep apnea.Sleep Breath. 2014; 18: 901-905
- Early improvement in obstructive sleep apnea and increase in orexin levels after bariatric surgery in adolescents and young adults.Surg Obes Relat Dis. 2017; 13: 95-100
- Obstructive sleep apnea in extremely overweight adolescents undergoing bariatric surgery.Obes Res. 2005; 13: 1175-1179
- Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline.J Clin Sleep Med. 2017; 13: 479-504
- OSA screening with the pediatric sleep questionnaire for adolescents undergoing bariatric surgery in teen-LABS.Obesity (Silver Spring). 2016; 24: 2392-2398
- Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline.J Clin Sleep Med. 2019; 15: 335-343
- Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine.J Clin Sleep Med. 2012; 8: 597-619
- Obstructive sleep apnea in children and adolescents with and without obesity.Eur Arch Otorhinolaryngol. 2019; 276: 871-878
- Laparoscopic sleeve gastrectomy in adolescents with or without syndromic obesity: two years follow-up.Eat Weight Disord. 2018; 23: 479-486
- The beneficial effect of weight reduction on adverse cardiovascular outcomes following bariatric surgery is attenuated in patients with obstructive sleep apnea.Sleep. 2018; 41: zsy028
- Postoperative CPAP use impacts long-term weight loss following bariatric surgery.J Clin Sleep Med. 2015; 11: 213-217
- Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea.J Pediatr. 1995; 127: 88-94
- Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? A systematic review and comparison of meta-analyses.Obes Surg. 2015; 25: 1239-1250
- Sleeve gastrectomy improves obstructive sleep apnea syndrome (OSAS): 5 year longitudinal study.Surg Obes Relat Dis. 2016; 12: 70-74
Article info
Publication history
Published online: December 16, 2020
Accepted:
December 6,
2020
Received:
June 11,
2020
Identification
Copyright
© 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
