Dixon J B, Schachter L M, O'Brien P E
Department of Surgery, Monash University-Alfred Hospital, Melbourne 3181, Victoria, Australia.
Arch Intern Med. 2001 Jan 8;161(1):102-6. doi: 10.1001/archinte.161.1.102.
Obesity causes sleep disturbance and is the most significant risk factor for sleep apnea. Only surgical methods provide substantial sustained weight loss for most severely obese subjects.
To study sleep disturbance in patients undergoing laparoscopic adjustable gastric banding with a commercially available product (Lap-Band).
In this study, 313 consecutive patients with severe obesity (body mass index [calculated as weight in kilograms divided by the square of height in meters] >35) completed a preoperative sleep questionnaire and clinical assessment. One hundred twenty-three patients completed the same assessment 12 months after surgery. The characteristics of sleep disturbance and changes in responses to weight loss have been assessed.
There was a high prevalence of significantly disturbed sleep in men (59%) and women (45%), with women less likely to have had their sleep disturbance investigated. Observed sleep apnea was more common in men, but daytime sleepiness was not affected by sex. Waist circumference was the best clinical measure predicting observed sleep apnea (R = 0.36; P<.001). The group lost an average of 48% (SD, 16%) of excess weight by 12 months. There was a significant improvement in the responses to all questions at follow-up, with habitual snoring reduced to 14% (preoperative value, 82%), observed sleep apnea to 2% (preoperative value, 33%), abnormal daytime sleepiness to 4% (preoperative value, 39%), and poor sleep quality to 2% (preoperative value, 39%) (P<.001 for all).
Obesity-related sleep disorders improve markedly with weight loss. Sustainable weight loss should be a primary aim in the management of severely obese patients with significant sleep disturbance, including sleep apnea. Low-risk laparoscopic obesity surgery should be considered for selected patients with this important comorbidity.
肥胖会导致睡眠障碍，是睡眠呼吸暂停最重要的危险因素。对于大多数重度肥胖患者而言，只有手术方法才能实现显著且持续的体重减轻。
研究使用市售产品（胃束带）进行腹腔镜可调节胃束带手术患者的睡眠障碍情况。
在本研究中，313例连续入选的重度肥胖患者（体重指数[按千克体重除以米身高的平方计算]>35）完成了术前睡眠问卷和临床评估。123例患者在术后12个月完成了相同评估。对睡眠障碍的特征以及体重减轻后的反应变化进行了评估。
男性（59%）和女性（45%）中存在明显睡眠障碍的患病率较高，女性接受睡眠障碍检查的可能性较小。观察到的睡眠呼吸暂停在男性中更常见，但白天嗜睡不受性别影响。腰围是预测观察到的睡眠呼吸暂停的最佳临床指标（R = 0.36；P<0.001）。到12个月时，该组患者平均减轻了48%（标准差，16%）的超重体重。随访时所有问题的回答均有显著改善，习惯性打鼾降至14%（术前值为82%），观察到的睡眠呼吸暂停降至2%（术前值为33%），异常白天嗜睡降至4%（术前值为39%），睡眠质量差降至2%（术前值为39%）（所有P<0.001）。
肥胖相关的睡眠障碍会随着体重减轻而显著改善。对于伴有明显睡眠障碍（包括睡眠呼吸暂停）的重度肥胖患者，可持续的体重减轻应是管理的首要目标。对于患有这种重要合并症的特定患者，应考虑低风险的腹腔镜肥胖手术。
