Diabetes Department, Sandwell & West Birmingham NHS Trust, Birmingham, UK.
Research and Development, Sandwell & West Birmingham NHS Trust, Birmingham, UK.
Clin Obes. 2024 Dec;14(6):e12694. doi: 10.1111/cob.12694. Epub 2024 Aug 11.
We aimed to assess the extent to which people with type 2 diabetes or pre-diabetes, obesity (BMI 30-45 kg/m) and moderate obstructive sleep apnoea (OSA) requiring continuous positive airway pressure ventilation (CPAP) were able to discontinue CPAP following EndoBarrier-related weight loss. We assessed sleep and metabolic parameters before, during and after EndoBarrier in 12 participants with moderate OSA requiring CPAP (75% female, 8/12 [66%] type 2 diabetes, 4/12 [34%] prediabetes, mean ± SD age 52.6 ± 9.7 years, BMI 37.4 ± 3.5 kg/m, median duration of OSA while on CPAP 9.0 [7.0-15.0] months). With EndoBarrier in-situ, mean ± SD Apnoea Hypopnoea Index (AHI) fell by 9.1 ± 5.0 events/h from 18.9 ± 3.8 to 9.7 ± 3.0 events/h (p < .001) with an associated reduction in symptoms of daytime sleepiness (mean Epworth Sleepiness Score) such that all the 12 participants no longer required CPAP according to National Institute for Health and Care Excellence criteria. After EndoBarrier removal, 10/12 (83%) patients attended follow-up and at 12 months after removal, AHI remained below 15 in 5/10 (50%) patients but in other five the AHI rose above 15 such that restarting CPAP was recommended as justified by their symptoms. Rather than restart CPAP, two patients lost the regained weight and their AHI dropped below 15 again. Thus, 7/10 (70%) of patients were able to remain off CPAP 12 or more months after EndoBarrier removal. These results demonstrate major benefit of EndoBarrier in moderate OSA, allowing all patients to discontinue CPAP during treatment, and with maintenance of improvement at follow-up in 70%. They confirm previously demonstrated metabolic improvements in diabetes and obesity.
我们旨在评估患有 2 型糖尿病或前期糖尿病、肥胖症（BMI 为 30-45kg/m²）和中度阻塞性睡眠呼吸暂停（OSA）需要持续气道正压通气（CPAP）的人群在接受 EndoBarrier 减肥相关治疗后停止 CPAP 的程度。我们在 12 名需要 CPAP 的中度 OSA 患者（75%为女性，12 名患者中有 8 名[66%]患有 2 型糖尿病，4 名[34%]患有前期糖尿病，平均年龄 52.6±9.7 岁，BMI 37.4±3.5kg/m²，CPAP 治疗期间 OSA 的中位持续时间为 9.0[7.0-15.0]个月）接受 EndoBarrier 治疗前后评估睡眠和代谢参数。当 EndoBarrier 就位时，平均±SD 呼吸暂停低通气指数（AHI）从 18.9±3.8 降至 9.7±3.0 事件/小时（p<.001），同时日间嗜睡症状（平均 Epworth 嗜睡评分）也得到改善，因此根据国家健康与临床卓越研究所的标准，12 名患者均不再需要 CPAP。EndoBarrier 去除后，12 名患者中有 10 名（83%）参加了随访，在去除后 12 个月，10 名患者中有 5 名（50%）的 AHI 仍低于 15，但另外 5 名患者的 AHI 上升到 15 以上，因此根据症状建议重新开始 CPAP。这 5 名患者中，有 2 名患者体重反弹，AHI 再次降至 15 以下，无需重新开始 CPAP。因此，10 名患者中有 7 名（70%）在 EndoBarrier 去除后 12 个月或更长时间内能够继续停用 CPAP。这些结果表明 EndoBarrier 在中度 OSA 中的显著益处，允许所有患者在治疗期间停止使用 CPAP，并且在 70%的患者中维持随访时的改善。它们证实了先前在糖尿病和肥胖症中观察到的代谢改善。
