Bariatric Surgery And Sleep Apnea

Professor Of SurgeryDepartment Of Surgery

Damascus University

• 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).

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.

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.

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.

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.

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).

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.

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.

For Significant OSA:1. CPAP Therapy.2. Bariatric Surgery.3. Tracheostomy.

Management:

3. Tracheostomy.4. Mandibular/Maxillary Advancement Surgery In

Highly Selected Cases.

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.

Bariatric Surgery Laparoscopic Sleeve Gastrectomy

Bariatric Surgery Laparoscopic Sleeve Gastrectomy

Bariatric Surgery Mini Gastric Bypass

Bariatric Surgeries

Vertical Banded Gastroplasty (VBG) Adjustable Gastric Banding (LAGB)

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.

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).