Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother (QEQM) Building, Imperial College Healthcare NHS Trust at St Mary's Hospital, Praed Street, London W2 1NY, UK.
Thorax. 2012 May;67(5):442-9. doi: 10.1136/thx.2010.151225. Epub 2011 Jun 27.
The global epidemic of obesity and the worldwide prevalence of obstructive sleep apnoea (OSA) are both increasing. Epidemiological studies reveal an association between obesity, weight gain and OSA. Metabolic or bariatric operations provide sustained weight loss and resolve or improve the symptoms of OSA in the majority of morbidly obese individuals. These operations also modulate the metabolic profile to improve glycaemic control, to decrease cardiovascular risk and obesity-related mortality. The beneficial effects of metabolic operations on OSA include mechanical weight-dependent and metabolic weight-independent effects that are achieved through the BRAVE effects: (Bile flow alteration; Reduction of gastric size; Anatomical gut rearrangement and altered flow of nutrients; Vagal manipulation; and Enteric gut hormone modulation). These result in an improvement in insulin resistance, adipokines, cytokines and systemic inflammation. A literature analysis was performed with statistical pooling of available surgical and medical studies to determine whether the weighted mean decrease in body mass index and sleep apnoea severity (measured by the apnoea-hypopnoea index) are larger in metabolic surgical studies than in non-surgical weight loss studies (diet, exercise and medication). However, heterogeneity across available trials, poor follow-up measures and a deficiency in comparative studies between surgical and non-surgical therapy precludes definitive statements regarding the relative benefits of surgical therapy. Further research is required to quantify robustly the effects and mechanisms of sleep apnoea resolution by metabolic surgery, which may reveal novel non-surgical treatments or enhanced surgical strategies in the management of this multisystem sleep disorder.
肥胖症在全球流行，阻塞性睡眠呼吸暂停（OSA）在全球也普遍存在。流行病学研究揭示了肥胖、体重增加与 OSA 之间存在关联。代谢或减肥手术能持续减重，并解决或改善大多数病态肥胖患者的 OSA 症状。这些手术还能调节代谢特征，改善血糖控制，降低心血管风险和肥胖相关死亡率。代谢手术对 OSA 的有益影响包括机械性体重依赖和代谢性体重独立的影响，这是通过 BRAVE 效应实现的：（胆汁流量改变；胃容量减少；肠道解剖结构重新排列和营养物质流动改变；迷走神经操作；以及肠道激素调节）。这些影响导致胰岛素抵抗、脂肪因子、细胞因子和全身炎症的改善。对现有手术和医学研究进行了文献分析，并进行了统计学汇总，以确定代谢手术研究中体重指数和睡眠呼吸暂停严重程度（通过呼吸暂停低通气指数测量）的加权平均下降是否大于非手术减肥研究（饮食、运动和药物）。然而，由于可用试验的异质性、随访措施不佳以及手术与非手术治疗之间缺乏比较研究，因此无法对手术治疗的相对益处做出明确的结论。需要进一步研究来量化代谢手术对睡眠呼吸暂停缓解的效果和机制，这可能会揭示新的非手术治疗方法或增强这种多系统睡眠障碍的管理中的手术策略。
