Lankford D Alan, Proctor Charles D, Richard Robert
Sleep Disorders Center of Northeast Georgia Medical Center, Gainesville, GA 30342, USA.
Obes Surg. 2005 Mar;15(3):336-41. doi: 10.1381/0960892053576749.
Obstructive sleep apnea (OSA) is a common condition in morbidly obese patients, with the reported prevalence ranging from 12-78%. There is increasing recognition of the need to diagnose and treat/manage OSA both preoperatively and postoperatively. Nasal CPAP is the preferred treatment of OSA; however, weight loss is associated with a reduction in required pressures. We evaluated the CPAP pressure requirements in a group of patients undergoing rapid weight loss following Roux-en-Y gastric bypass.
15 patients who had been diagnosed with OSA before surgery were retrospectively evaluated. All patients had demonstrated compliance on home CPAP therapy, were minimally 3 months post-surgery and had follow-up reports that their CPAP was less effective. We obtained data on age, sex, weight, BMI, and apnea/hypopnea index (AHI). Optimal CPAP pressure was obtained initially through attended in-laboratory complex polysomnography. Follow-up CPAP pressure was obtained using an auto-titrating PAP device at home. These data were used to evaluate the pressure changes that accompanied weight loss.
This group of patients had lost an average of 44.5 +/- 19.4 kg. Four patients had achieved their goal weight. Their starting CPAP pressures averaged 11 +/- 3.0 cm H2O, with a range of 7-18 cm H2O. Follow-up CPAP pressures averaged 9 +/- 2.7 cm H2O, with a range of 4-12 cm H2O, representing an overall reduction of 18%. The subgroup of patients who had achieved goal weight had a pressure reduction of 22% (9 +/- 2.0 to 7 +/- 1.0 cm H2O).
CPAP pressure requirements change considerably in bariatric surgery patients undergoing rapid weight loss. Auto-titrating PAP devices have promise for facilitating the management of CPAP therapy during this time. Consideration should also be given to the use of autotitrating PAP units as the treatment of choice in these patients.
阻塞性睡眠呼吸暂停（OSA）在病态肥胖患者中很常见，报道的患病率在12%至78%之间。术前和术后诊断和治疗/管理OSA的必要性日益受到认可。鼻持续气道正压通气（CPAP）是OSA的首选治疗方法；然而，体重减轻与所需压力的降低有关。我们评估了一组接受Roux-en-Y胃旁路术后快速减重患者的CPAP压力需求。
对15例术前被诊断为OSA的患者进行回顾性评估。所有患者均已证明在家中使用CPAP治疗依从性良好，术后至少3个月，且有随访报告显示其CPAP效果不佳。我们获取了年龄、性别、体重、体重指数（BMI）和呼吸暂停/低通气指数（AHI）的数据。最初通过在实验室进行的复杂多导睡眠图检查获得最佳CPAP压力。在家中使用自动调压型 PAP 设备获得随访CPAP压力。这些数据用于评估伴随体重减轻的压力变化。
这组患者平均减重44.5±19.4千克。4例患者达到了目标体重。他们开始时的CPAP压力平均为11±3.0厘米水柱，范围为7至18厘米水柱。随访CPAP压力平均为9±2.7厘米水柱，范围为4至12厘米水柱，总体降低了18%。达到目标体重的患者亚组压力降低了22%（从9±2.0降至7±1.0厘米水柱）。
接受快速减重的减肥手术患者的CPAP压力需求变化很大。自动调压型PAP设备有望在此期间促进CPAP治疗的管理。还应考虑将自动调压型PAP设备作为这些患者的首选治疗方法。
