Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France.
Univ. Grenoble Alpes, Inserm, U1300, "Hypoxia-physiopathology" Laboratory, Grenoble Alpes University Hospital, "Pôle Thorax et Vaisseaux", Grenoble, France.
Int J Obes (Lond). 2021 Nov;45(11):2388-2395. doi: 10.1038/s41366-021-00903-5. Epub 2021 Aug 27.
BACKGROUND/OBJECTIVES: Although the benefits of bariatric surgery have been clearly established, it is not known whether they are as important in patients with obstructive sleep apnoea (OSA). Primary aim: to evaluate whether patients with moderate-to-severe OSA (apnoea-hypopnea index (AHI) ≥ 15 events/h) treated by continuous positive airway pressure/non-invasive ventilation (median [IQR] adherence 6.5 h/night [5; 7.9] at baseline) lose the same amount of body weight 1 year after bariatric surgery as patients with no or mild OSA. Secondary objectives: to compare the evolution of type 2 diabetes and hypertension after bariatric surgery, and surgical complication rates between groups.
METHODS/SUBJECTS: Analyses were performed in 371 patients included in a prospective cohort of bariatric surgery, the Severe Obesity Outcome Network cohort. Subjects having moderate-to-severe OSA (n = 210) at baseline were compared with other subjects (n = 161).
Excess weight loss (%EWL) at 1 year was lower in patients with moderate-to-severe OSA than in patients without (64.9%EWL [46.9; 79.5] vs. 73.8%EWL [56.6; 89.3], p < 0.01). Multivariable analysis showed that age, initial body mass index and type of surgery, but not OSA status, were associated with 1-year %EWL. Diabetes remitted in 25 (41%) patients with moderate-to-severe OSA and 16 (48%) patients with no or mild OSA (p = 0.48). Hypertension remitted in 28 (32.9%) patients with moderate-to-severe OSA and 9 (40.9%) with no or mild (p = 0.48). Complication rates were 28 (13.3%) in patients with moderate-to-severe OSA and 12 (7.5%) in patients with no or mild OSA (p = 0.07).
Patients with OSA lose less body weight after bariatric surgery. This was related to older age and a higher baseline body mass index. However, the improvements of diabetes and hypertension were similar to that of patients without OSA, and the risk of surgical complications was not higher.
背景/目的：尽管减重手术的益处已得到明确证实，但对于合并阻塞性睡眠呼吸暂停（OSA）的患者是否同样重要尚不清楚。主要目的：评估经持续气道正压通气/无创通气（基线时的中位[IQR]依从率为 6.5 小时/夜[5；7.9]）治疗的中重度 OSA（呼吸暂停-低通气指数（AHI）≥15 次/小时）患者与无或轻度 OSA 患者相比，在减重手术后 1 年时减轻的体重量是否相同。次要目标：比较两组患者 2 型糖尿病和高血压的术后演变以及手术并发症发生率。
方法/对象：对前瞻性减重手术队列（严重肥胖结局网络队列）中的 371 名患者进行了分析。将基线时有中重度 OSA（n=210）的患者与其他患者（n=161）进行了比较。
与无 OSA 的患者相比，中重度 OSA 患者 1 年时的体重减轻量（%EWL）较低（64.9%EWL[46.9；79.5]与 73.8%EWL[56.6；89.3]，p<0.01）。多变量分析显示，年龄、初始体重指数和手术类型，但不是 OSA 状态，与 1 年时的%EWL 相关。25 例（41%）中重度 OSA 患者和 16 例（48%）无或轻度 OSA 患者的糖尿病得到缓解（p=0.48）。28 例（32.9%）中重度 OSA 患者和 9 例（40.9%）无或轻度 OSA 患者的高血压得到缓解（p=0.48）。中重度 OSA 患者的并发症发生率为 28（13.3%），无或轻度 OSA 患者为 12（7.5%）（p=0.07）。
合并 OSA 的患者在减重手术后减轻的体重较少。这与年龄较大和基线体重指数较高有关。然而，糖尿病和高血压的改善与无 OSA 的患者相似，手术并发症的风险也没有更高。
