Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial

Isabella C. Aguiar; Wilson R. Freitas jr.; Israel R. Santos; Nadua Apostolico; Sergio R. Nacif; Jéssica Julioti Urbano; Nina Teixeira Fonsêca; Fabio Rodrigues Thuler; Elias Jirjoss Ilias; Paulo Kassab; Fernando S.S. Leitão Filho; Rafael M. Laurino Neto; Carlos A. Malheiros; Giuseppe Insalaco; Claudio F. Donner; Luis Vicente F. Oliveira

doi:10.4081/mrm.2014.378

Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial

Authors

Isabella C. Aguiar Sleep Laboratory; Master’s and PhD Degree Pos Graduation Programs in Rehabilitation Sciences, Nove de Julho University (UNINOVE), Sao Paulo, SP
Wilson R. Freitas jr. Surgery Department, Santa Casa de Misericórdia Hospital, Sao Paulo, SP
Israel R. Santos Sleep Laboratory; Master’s and PhD Degree Pos Graduation Programs in Rehabilitation Sciences, Nove de Julho University (UNINOVE), Sao Paulo, SP
Nadua Apostolico Sleep Laboratory; Master’s and PhD Degree Pos Graduation Programs in Rehabilitation Sciences, Nove de Julho University (UNINOVE), Sao Paulo, SP
Sergio R. Nacif Sleep Laboratory; Master’s and PhD Degree Pos Graduation Programs in Rehabilitation Sciences, Nove de Julho University (UNINOVE), Sao Paulo, SP
Jéssica Julioti Urbano Sleep Laboratory; Master’s and PhD Degree Pos Graduation Programs in Rehabilitation Sciences, Nove de Julho University (UNINOVE), Sao Paulo, SP
Nina Teixeira Fonsêca Sleep Laboratory; Master’s and PhD Degree Pos Graduation Programs in Rehabilitation Sciences, Nove de Julho University (UNINOVE), Sao Paulo, SP
Fabio Rodrigues Thuler Surgery Department, Santa Casa de Misericórdia Hospital, Sao Paulo, SP
Elias Jirjoss Ilias Surgery Department, Santa Casa de Misericórdia Hospital, Sao Paulo, SP
Paulo Kassab Surgery Department, Santa Casa de Misericórdia Hospital, Sao Paulo, SP
Fernando S.S. Leitão Filho Medicine School, Universidade de Fortaleza, Fortaleza
Rafael M. Laurino Neto Bariatric Surgery Service, Conjunto Hospitalar do Mandaqui, Sao Paulo, SP
Carlos A. Malheiros Surgery Department, Santa Casa de Misericórdia Hospital, Sao Paulo, SP
Giuseppe Insalaco A. Monroy Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo
Claudio F. Donner Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero (NO)
Luis Vicente F. Oliveira Sleep Laboratory; Master’s and PhD Degree Pos Graduation Programs in Rehabilitation Sciences, Nove de Julho University (UNINOVE), Sao Paulo, SP

DOI: https://doi.org/10.4081/mrm.2014.378

Keywords:

Bariatric surgery, Pulmonary function, Severe obesity, Sleep disorders, Ventilatory muscles

Abstract

Background: The increasing prevalence of obesity in both developed and developing countries is one of the most serious public health problems and has led to a global epidemic. Obesity is one of the greatest risk factors of obstructive sleep apnea (OSA), which is found in 60 to 70% of obese patients mainly due to the buildup of fat tissue in the upper portion of the thorax and neck. The aim of the present randomized clinical trial is to assess daytime sleepiness, sleep architecture and pulmonary function in patients with severe obesity before and after bariatric surgery.

Methods: This randomized, controlled trial, was designed, conducted, and reported in accordance with the standards of The CONSORT (Consolidated Standards of Reporting Trials) Statement. Patients were divided into a bariatric surgery group and control group. The clinical evaluation was performed at the Sleep Laboratory of the Nove de JulhoUniversity (Sao Paulo, Brazil) and consisted of the collection of clinical data, weight, height, body mass index (BMI), measurements of neck and abdomen circumferences, spirometry, maximum ventilatory pressure measurements, standard overnight polysomnography (PSG) and the administration of the Berlin Questionnaire and Epworth Sleepiness Scale.

Results: Fifty-two patients participated in the present study and performed PSG. Out of these, 16 underwent bariatric surgery. After surgery, mean BMI decreased from 48.15 ± 8.58 to 36.91 ± 6.67 Kg/m2. Significant differences were found between the preoperative and postoperative periods regarding neck (p < 0.001) and waist circumference (p < 0.001), maximum inspiratory pressure (p = 0.002 and p = 0.004) and maximum expiratory pressure (p = 0.001 and p = 0.002) for women and men, respectively, as well as sleep stage N3 (p < 0.001), REM sleep (p = 0.049) and the apnea-hypopnea index (p = 0.008).

Conclusions: Bariatric surgery effectively reduces neck and waist circumference, increases maximum ventilatory pressures, enhances sleep architecture and reduces respiratory sleep disorders, specifically obstructive sleep apnea, in patients with severe obesity.

Trial registration: The protocol for this study was registered with the World Health Organization (Universal Trial Number: U1111-1121-8873) and Brazilian Registry of Clinical Trials – ReBEC (RBR-9k9hhv).