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【medical-news】肥胖症的外科治疗可改善阻塞性睡
“Weight loss may reduce the severity of [OSA], but persistence of OSA following surgical weight loss has not been defined,” write Christopher J. Lettieri, MD, from Walter Reed Army Medical Center in Washington, DC, and colleagues. “We sought to clarify the impact of bariatric surgery on OSA. We hypothesized that, despite substantial weight loss and reductions in the apnea-hypopnea index (AHI), many will have persistent disease.”
Before and 1 year following bariatric surgery, polysomnography was performed on consecutive patients referred for preoperative sleep evaluation, and the effects of weight loss on body mass, OSA, and continuous positive airway pressure (CPAP) requirements were determined. OSA severity was defined according to the AHI, with “normal” defined as fewer than 5 events per hour, "mild OSA” as 5 to 14 events per hour, “moderate OSA” as 15 to 29 events per hour, and “severe OSA” as 30 or more events per hour. The investigators determined predictors of OSA severity following weight loss as well as compliance with treatment.
The study sample consisted of 24 patients with OSA, of whom 75% were women. Mean age was 47.9 ± 9.3 years, and most participants had severe OSA at baseline. Weight loss was associated with reduction in body mass index from 51.0 ± 10.4 kg/m2 to 32.1 ± 5.5 kg/m2 (P < .001) and in AHI from 47.9 ± 33.8 to 24.5 ± 18.1 events per hour (P < .001).
Only 1 patient (4%) had resolution of OSA at follow-up, whereas most (71%) had moderate or severe disease. The baseline AHI was the most important predictor of the follow-up AHI (R2 = 0.603). CPAP was needed to correct apneic events in all patients with residual OSA. However, the required pressures decreased from 11.5 ± 3.6 cm H2O to 8.4 ± 2.1 cm H2O (P = .001). At the follow-up visit, only 6 patients reported being compliant with CPAP treatment.
Limitations of this study include cohort representing only 20% of those undergoing bariatric procedures at this institution; possible selection bias; OSA seen in every referred patient, suggesting that the threshold for referral may be too high; lack of anthropometric data on all subjects; limited sample size; and problematic definition of meaningful response following surgical weight loss.
“Surgical weight loss reduces the AHI, but many patients have residual OSA one year after bariatric surgery,” the study authors write. “Due to negative impacts on health and quality of life associated with OSA, it is recommended that patients continue CPAP therapy and undergo reevaluation with polysomnography to assess for residual disease following surgical weight loss regardless of potential subjective improvements in sleep-related symptoms.”
This was not an industry-supported study, and the authors have disclosed no relevant financial relationships.
J Clin Sleep Med. 2008;4:333-338. [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-03-06 17:14
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