减重手术后阻塞性睡眠呼吸暂停缓解：全国登记队列研究。

Obstructive sleep apnea remission following bariatric surgery: a national registry cohort study.

机构信息

Department of Bariatric Surgery, Ashford & St Peter's Hospital NHS Trust, Chertsey, United Kingdom.

Department of Upper GI Surgery, Epsom & St Helier NHS Trust, Epsom, United Kingdom.

出版信息

Surg Obes Relat Dis. 2021 Sep;17(9):1576-1582. doi: 10.1016/j.soard.2021.05.021. Epub 2021 May 21.

DOI:10.1016/j.soard.2021.05.021

PMID:34187745

Abstract

BACKGROUND

Obstructive sleep apnea (OSA) is strongly associated with metabolic syndrome. Bariatric surgery is an effective available treatment for OSA; however, limited research predicts which patients undergoing bariatric surgery will undergo OSA resolution.

OBJECTIVES

To determine perioperative predictors for OSA resolution following bariatric surgery using a national database.

SETTING

United Kingdom national bariatric surgery database.

METHODS

The UK National Bariatric Surgery Registry (NBSR) was interrogated to identify all patients with OSA that underwent primary bariatric surgery between January 2009 and June 2017. Those with at least 1 follow-up recording postoperative OSA status were selected for further analysis. Demographic, pre- and postoperative outcomes were collected and analyzed. Poisson multivariate regression was conducted to identify predictors of OSA remission.

RESULTS

A total of 4015 bariatric cases were eligible for inclusion: 2482 (61.8%) patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), 1196 (29.8%) sleeve gastrectomy (LSG), and 337 (8.4%) adjustable gastric banding (LAGB). Overall, the mean excess weight loss (EWL) % for the whole group was 61.2 (SD ± 27.2). OSA resolution was recorded in 2377 (59.2%) patients. Following Poisson regression, LRYGB (risk ratio [RR], 1.49 confidence interval [CI] 1.25-1.78) and LSG (RR, 1.46 [CI 1.22-1.75] were associated with approximately 50% increased likelihood of OSA remission compared with LAGB. Greater weight loss following intervention was associated with greater likelihood of OSA remission, while both greater age and greater preoperative body mass index (BMI) were associated with reduced likelihood of OSA remission (P < .001).

CONCLUSION

This study demonstrated that metabolic surgery results in OSA remission in the majority of patients with obesity. Younger age, lower BMI preprocedure, greater %EWL and the use of LSG or LRYGB positively predicted OSA remission.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）与代谢综合征密切相关。减重手术是治疗 OSA 的有效方法；然而，有限的研究预测哪些接受减重手术的患者将解决 OSA。

目的

使用国家数据库确定减重手术后 OSA 缓解的围手术期预测因素。

设置

英国国家减重手术数据库。

方法

英国国家减重手术登记处（NBSR）被询问以确定 2009 年 1 月至 2017 年 6 月期间接受过主要减重手术的所有 OSA 患者。选择至少有 1 个术后记录术后 OSA 状态的患者进行进一步分析。收集并分析人口统计学、术前和术后结果。进行泊松多变量回归以确定 OSA 缓解的预测因素。

结果

共有 4015 例减重手术符合纳入标准：2482 例（61.8%）患者接受腹腔镜 Roux-en-Y 胃旁路术（LRYGB），1196 例（29.8%）袖状胃切除术（LSG）和 337 例（8.4%）可调节胃束带术（LAGB）。总体而言，整个组的平均超重体重减轻（EWL）%为 61.2（SD ± 27.2）。2377 例（59.2%）患者记录了 OSA 缓解。经泊松回归，LRYGB（风险比 [RR]，1.49 置信区间 [CI] 1.25-1.78）和 LSG（RR，1.46 [CI 1.22-1.75]）与 LAGB 相比，OSA 缓解的可能性增加了约 50%。干预后体重减轻越多，OSA 缓解的可能性越大，而年龄越大和术前体重指数（BMI）越高，OSA 缓解的可能性越低（P<.001）。