Early improvement in obstructive sleep apnea and increase in orexin levels after bariatric surgery in adolescents and young adults

Abstract

Background: Obstructive sleep apnea (OSA) associated with obesity is known to improve after bariatric surgery, but little is known about early changes in this condition after surgery.

Objectives: To study the clinical course of OSA after bariatric surgery SETTING: Children's hospital in the United States METHODS: Adolescents and young adults with obstructive sleep apnea undergoing vertical sleeve gastrectomy (n = 6) or gastric bypass (n = 1) were enrolled in this prospective study. Participants underwent formal polysomnography before and at 3 and 5 weeks after bariatric surgery. Anthropometric measurements and assay for orexin and leptin were also performed at study visits. Thirty-one adolescents who underwent 2 polysomnography studies that were 4 weeks apart served as control patients.

Results: Baseline mean (range) age of participants was 17.8 (15.4-20.7) years, 71% were male, with body mass index of 55.2 (41.3-61.6) kg/m2 and had a median apnea hypopnea index (AHI) of 15.8 (7.1-23.8) events/hour. Differences in least-square means from longitudinal analysis did not show significant differences in AHI in the control group but showed significant postoperative decline in AHI relative to baseline. AHI declined postoperatively from baseline by 9.2 events/hour (95% confidence interval: 3.8 to 14.5) at 3 weeks (P = .002) and 9.1 events/hour (95% confidence interval: 3.8 to 14.5) at 5 weeks (P = .002); there was no significant change from 3 to 5 weeks in AHI. Leptin decreased and orexin levels increased significantly by 3 weeks postoperatively.

Conclusions: These observations suggest that OSA responds early and out of proportion to weight loss after metabolic and or bariatric surgery, thus weight independent factors may at least in part be responsible for early improvement in OSA postoperatively.

Keywords: Leptin; Orexin; Polysomnography; Sleep apnea; Sleeve gastrectomy.

Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1. Severity of sleep apnea and changes in blood pressure before and after surgery

Panel A AHI= apnea hypopnea index AHI at baseline, 3 and 5 weeks after bariatric surgery. P-values obtained by repeated measures analysis with Tukey adjustment for multiple comparisons. Panel B Systolic and Diastolic blood pressure at baseline, 3 and 5 weeks after bariatric surgery. P-values obtained by repeated measures analysis with Tukey adjustment for multiple comparisons.

Figure 1. Severity of sleep apnea and changes in blood pressure before and after surgery

Panel A AHI= apnea hypopnea index AHI at baseline, 3 and 5 weeks after bariatric surgery. P-values obtained by repeated measures analysis with Tukey adjustment for multiple comparisons. Panel B Systolic and Diastolic blood pressure at baseline, 3 and 5 weeks after bariatric surgery. P-values obtained by repeated measures analysis with Tukey adjustment for multiple comparisons.

Figure 2. Orexin and Leptin changes

Panel A Plasma Orexin at baseline, 3 and 5 weeks after bariatric surgery. P-values obtained by repeated measures analysis with Tukey adjustment for multiple comparisons. Panel B Serum Leptin at baseline, 3 and 5 weeks after bariatric surgery. P-values obtained by repeated measures analysis with Tukey adjustment for multiple comparisons.

Figure 2. Orexin and Leptin changes

Panel A Plasma Orexin at baseline, 3 and 5 weeks after bariatric surgery. P-values obtained by repeated measures analysis with Tukey adjustment for multiple comparisons. Panel B Serum Leptin at baseline, 3 and 5 weeks after bariatric surgery. P-values obtained by repeated measures analysis with Tukey adjustment for multiple comparisons.