Valencia-Flores Matilde, Orea Arturo, Herrera Miguel, Santiago Victoria, Rebollar Verónica, Castaño Violeta A, Oseguera Jorge, Pedroza Jorge, Sumano Jorge, Resendiz Montserrat, García-Ramos Guillermo
Sleep Clinic of Neurology and Psychiatry Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
Obes Surg. 2004 Jun-Jul;14(6):755-62. doi: 10.1381/0960892041590773.
We evaluated the impact of surgically-induced weight loss on Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS), electrocardiographic changes, pulmonary arterial pressure and daytime sleepiness in morbidly obese patients.
16 women and 13 men (n=29) underwent bariatric surgery in a 3-year period. The following tests were performed before and 1 year after surgery: nocturnal polysomnography, daytime Multiple Sleep Latency Test (MSLT), and echocardiogram.
Mean age was 37.9+/-11 years (range 20-56). Preoperative body mass index was 56.5+/-12.3 kg/m(2) and it was 39.2+/-8.5 kg/m(2) at 13.7+/-6.6 months follow-up. Performed surgical procedures included: vertical banded gastroplasty in 6, Roux-en-Y gastric bypass in 12, and Distal Roux-en-Y gastric bypass in 11. Weight loss induced by surgery eliminated OSAHS in 46% of obese patients with an important improvement in oxygen saturation. Neck, thorax, waist and hip circumferences decreased significantly after surgical intervention but only neck circumference correlated significantly with the apnea/hypopnea index (Spearman rho=0.63, P <0.0001). Electrocardiographic abnormalities were present in 9 patients (31%) before surgery (sinus arrhythmia, ventricular arrhythmias, and sinus arrest). The number of electrocardiographic abnormalities decreased after surgery but new abnormalities appeared in some patients. Systolic pulmonary arterial pressure significantly decreased in the group of patients in whom OSAHS disappeared after surgery. Daytime sleepiness persisted after surgery in most patients.
Bariatric surgery effectively reduces respiratory disturbances during sleep and improves pulmonary hypertension. Electro cardiographic abnormalities change after surgery. Daytime sleepiness appeared not to be related to respiratory disturbances during sleep.
我们评估了手术引起的体重减轻对病态肥胖患者阻塞性睡眠呼吸暂停/低通气综合征（OSAHS）、心电图变化、肺动脉压和日间嗜睡的影响。
在3年期间，16名女性和13名男性（n = 29）接受了减肥手术。在手术前和术后1年进行了以下检查：夜间多导睡眠图、日间多次睡眠潜伏期测试（MSLT）和超声心动图。
平均年龄为37.9±11岁（范围20 - 56岁）。术前体重指数为56.5±12.3 kg/m²，在13.7±6.6个月的随访时为39.2±8.5 kg/m²。所实施的手术包括：6例垂直束带胃成形术、12例Roux-en-Y胃旁路术和11例远端Roux-en-Y胃旁路术。手术引起的体重减轻使46%的肥胖患者的OSAHS消失，氧饱和度有显著改善。手术干预后，颈部、胸部、腰围和臀围显著减小，但只有颈部周长与呼吸暂停/低通气指数显著相关（Spearman秩相关系数=0.63，P <0.0001）。术前9例患者（31%）存在心电图异常（窦性心律失常、室性心律失常和窦性停搏）。术后心电图异常数量减少，但一些患者出现了新的异常。在OSAHS术后消失的患者组中，收缩期肺动脉压显著降低。大多数患者术后仍存在日间嗜睡。
减肥手术有效减少睡眠期间的呼吸紊乱并改善肺动脉高压。术后心电图异常发生改变。日间嗜睡似乎与睡眠期间的呼吸紊乱无关。
