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Bariatric Surgery And Sleep Apnea
Professor Of SurgeryDepartment Of Surgery
Damascus University
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• Levels of obesity (BMI >30) are rising in all ‘civilized’ societies.
• In 1983, 8% in the UK (18% in the USA) had a BMI >30.
Obesity-related Respiratory Problems:
>30.• Twenty-five years later, in 2008, this was 24% in the
UK (34% in the USA).
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Obesity Particularly In Conjunction With :1. Obstructive Sleep Apnea (OSA).
2. COPD.3. Ventilatory Failure.
Obesity-related Respiratory Problems:
3. Ventilatory Failure.4. Cor Pulmonale.
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Definition :
It Is A Sleep Disorder Characterized By Pauses In Breathing Or Periods Of Shallow Breathing During Sleep.
Sleep Apnea :
Sleep.
There Are Three Forms Of Sleep Apnea:1- Obstructive (OSA)2- Central (CSA)3- Combination Of The Two Called Mixed.
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Causes:1. Mass loading from an obese or muscular neck.2. Neuromuscular diseases with pharyngeal
involvement.
Obstructive Sleep Apnea (OSA) :
involvement.3. Muscle relaxants such as sedatives and alcohol. 4. Increasing age.
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The Majority Of Patients With Significant OSA Are:
1. ♂.
2. Tend To Have A Combination Of Upper Body
Obstructive Sleep Apnea (OSA) :
2. Tend To Have A Combination Of Upper Body Obesity.
3. Neck Circumference >17in.4. Relatively Undersized Or Set-back Mandible.
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Clinical Features:1. Excessive Sleepiness.2. Loud Snoring And Apneic Episodes.
Obstructive Sleep Apnea (OSA) :
3. Wakes Up Choking From Time To Time.4. Poor Concentration .5. Unrefreshing Sleep And Waking Unrefreshed.6. Nocturia (True Nocturia With Reversal Of The
Usual Day/Night Ratio).
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Diagnosis:It Is Often Based On A Combination Of Patient History And Tests:
Obstructive Sleep Apnea (OSA) :
1. Overnight Oximetry.2. Respiratory Polysomnography (PSG).3. Full PSG.
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For Snorers And Mild OSA :1. Weight Loss.2. Reduce Evening Alcohol Consumption. 3. Sleep Decubitus, Rather Than Supine, And With The
Management:
3. Sleep Decubitus, Rather Than Supine, And With The Bedhead Elevated.
4. Mandibular Advancement Devices.5. Pharyngeal Surgery As A Last Resort.
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For Significant OSA:1. CPAP Therapy.2. Bariatric Surgery.3. Tracheostomy.
Management:
3. Tracheostomy.4. Mandibular/Maxillary Advancement Surgery In
Highly Selected Cases.
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1. Excessive Sleepiness.2. Loud Snoring or Apneic Episodes Recognized By
The Bed Partner.3. Wakes Up choking From Time To Time.
Our Criteria:
3. Wakes Up choking From Time To Time.4. Poor Concentration .5. CPAP Therapy.
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Bariatric Surgery Laparoscopic Sleeve Gastrectomy
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Bariatric Surgery Laparoscopic Sleeve Gastrectomy
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Bariatric Surgery Mini Gastric Bypass
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Bariatric Surgeries
Vertical Banded Gastroplasty (VBG) Adjustable Gastric Banding (LAGB)
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In The First 6 Months In 2018:• 21 Patients With OSA Underwent LSG.• 5 Patients Using CPAP.• Mean BMI 42.
Our Patients:
• Mean BMI 42.• Mean Age 48.• 15 Patients Were Males.• All Patients Had Excessive Sleepiness And Loud
Snoring.
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Fellow up For 6 Months:• All patient stop using CPAP after 2 months meanly.• Mean 56 EWL%.• Needs for Pharyngeal Surgery or
Our Patients:
• Needs for Pharyngeal Surgery or Mandibular/Maxillary Surgery (0 Patient).
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