Probably for many people the term obstructive sleep apnea is not a very familiar term, nevertheless it is a serious condition of the respiratory tract, very common in obese and not so obese patients.
Since the diagnosis is not made with a simple consultation and often goes unnoticed or underestimated, in reality it is a serious disease that puts at risk the life of the patient and those around him, since it is the most serious sleep disorder that exists.
Below we explain what it is and how weight loss surgery can contribute to its improvement or cure.
What is obstructive sleep apnea?
It is a very serious disease, resulting from the obstruction of the upper airway, which causes the patient to stop breathing for several seconds during sleep.
As previously mentioned, the diagnosis of Obstructive Sleep Apnea abbreviated as "OSA" is made with a test called "Polysomnography" (or sleep study) which consists of visual observation and certain clinical parameters such as brain waves, blood oxygen levels, respiration, and heart rate during the patient's sleep cycle. Based on the results of these records, it is that the diagnosis of OSA is reached.
What usually happens in these patients is the presence of apnea episodes (total cessation of breathing) and hypopnea (superficial and/or slow breathing). The suspicion of this diagnosis usually comes by reference from the couple or family member who observes how the patient during sleep has a snoring that is interrupted by an episode of silence of several seconds and then restart with another very loud snore which opens again the patient's airway.
The explanation of why the person stops breathing is that during sleep, when the muscles relax, the airways are narrowed or closed when inhaling and breathing may be insufficient for 10 to 20 seconds, this decreases the oxygen concentration in the blood and increases the levels of carbon dioxide. This, in turn, causes the brain to detect the situation and awakens the patient briefly from sleep to reopen the airway, but the patient is so tired that he does not notice these frequent and brief awakenings that continue throughout the night ( it is calculated that 5-30 episodes or more happen for each hour of sleep) which explains why the patient wakes up so tired despite having slept "well".
What are the signs and symptoms of OSA?
The signs and symptoms of obstructive sleep apnea include:
- Excessive sleepiness during the day
- Strong snoring
- Episodes of interruption of breathing during sleep
- Waking up suddenly gasping or choking
- Waking up with dry mouth or sore throat
- Morning headache
- Difficulty concentrating during the day
- Experiencing mood swings, depression or irritability
- High blood pressure
- Night sweats
- Decreased libido
Highly accurate indicators that you have this disease
- Waking up panting or choking
- Intermittent pauses of breathing during sleep
- Very loud snoring that interrupts your sleep or that of your partner
What are the risk factors for obstructive sleep apnea?
Some of the conditions that cause this disease are:
- Excess weight: As we will mention later, there is a close relationship between obesity and overweight and obstructive sleep apnea.
- Arterial Hypertension: People with high blood pressure are more likely to suffer from OSA.
- Narrow airways: Just as we are different from the outside, our body inside also varies from person to person and you can have narrower airways due to genetic causes.
- Smoking / Tobacco addiction: This vice also increases the chances of suffering from it.
- A family history of OSA: by inheritance, if a close family member has OSA you are at a higher of suffering from it.
- Diabetes: It has also been observed that diabetics more commonly suffer from this condition.
- Gender: Men are twice as likely than women to have it.
- Chronic nasal congestion: OSA is twice as frequent in people with chronic nasal congestion.
Some of the complications related to obstructive sleep apnea syndrome are:
- Pulmonary hypertension: Because of the increase in blood pressure due to OSA, the blood pressure of the pulmonary circulation system also increases, this is the final consequence of an undiagnosed or untreated OSA.
- Congestive heart failure: This consequence also goes hand in hand with changes in systemic and pulmonary blood pressure.
- Ischemic heart disease (myocardial infarction)
- Stroke (cerebral embolism)
- Cardiac arrhythmias (atrial fibrillation)
- Type 2 diabetes
- Early death
- Sudden death
- Traffic accidents
- Eye diseases: A relationship between OSA and glaucoma has been seen.
Incidence of Obstructive Sleep Apnea Syndrome in Obesity
There is a close and proportional relationship of this disease with the degree of obesity of the person since it is reported that 60 to 90% of patients who have a Body Mass Index equal to or greater than 30 have OSA, and this relationship it increases as the patient's weight increases.
In other words, the greater the obesity the greater the possibility of suffering from the disease. The incidence in the general population of OSA is from 2 to 4% while in obese people it rises to 45% of patients.
The reasons why people suffering from obesity also suffer from OSA are the following:
- Increase in fat deposits in the tissues surrounding the airway: This causes a decrease in the diameter of the airway, causing it to collapse more easily.
- Increase in fat deposits around the thorax: This reduces the capacity for expansion of the chest, causing an increase in the body's oxygen demand, since it reduces lung capacity.
Ironically, and to make matters worse, OSA itself has a predisposition to cause obesity as it increases appetite and reduces the person's ability to remain active due to the severe drowsiness it causes, the degree of drowsiness being such that there are patients who suffer traffic accidents for not being able to stay awake while driving. It is estimated an increase in the incidence of car crashes from 1 to 5 times that in the population that does not suffer it.
Obstructive sleep apnea treatment
In cases of mild OSA, less aggressive measures may be taken such as:
- Lose weight
- Perform exercise on a regular basis
- Give up smoking
- Drink alcohol moderately
- Avoid tranquilizers and/or sleeping pills
- Use nasal decongestant
- Use anti-allergy medications
- Sleeping on your stomach or on your side, and not on your back
Losing weight to cure Obstructive Sleep Apnea Syndrome
Unfortunately medical treatment for weight loss is ineffective in the long term in more than 80% of cases and the only thing available for the patient to improve their situation is the use of CPAP machine (Continuous Positive Airway Pressure) which consists of a device that is placed in the nose or nose and mouth at the time the patient goes to sleep, and when the device registers a decrease in airflow, pushes air with positive pressure to open the airway.
Although this device improves the patient’s situation by preventing the progression of the disease the compliance to treatment is far from optimal, it is estimated that only 46% of patients who have their CPAP machine use it "regularly" being this a use of only 4 hours in 70% of the days. And even more relevant is that this treatment does not cure the disease.
At present there are different modalities to address this disease:
- Surgical removal of tissue from the mouth and pharynx (uvulopalatopharyngoplasty)
- Stimulation of the upper respiratory tract (lingual nerve) with electrical impulses
- Jaw surgery (maxillomandibular advance)
- Surgical opening of the neck
- Implants (placement of polyester bars on the soft palate)
We did not want to delve into the previous modalities of treatment of obstructive sleep apnea because we consider that if a person who has OSA and suffers from obesity (a very frequent situation) it does not make much sense to leave aside an option that will not only help solve this respiratory disease but it will help your whole body to be healthier and this option is weight loss surgery.
To date, bariatric surgery is considered the most effective treatment modality since it provides a significant improvement of the disease or its cure, due to a sustained weight loss and improving not only the obstructive sleep apnea but all the obesity related diseases.
Putting this in numbers, an analysis was made of 69 studies in almost 14 thousand patients suffering from OSA and it was confirmed that bariatric surgery such as gastric sleeve and gastric bypass achieved if not cure, at least a considerable improvement of the disease in 75% of cases, confirming its effectiveness and the great benefits that these procedures entail in the resolution or improvement of this and many other diseases related to obesity.
It is important to let you know that if you are considering weight loss surgery and you suffer from this disease, first your bariatric surgeon will have to send you with the appropriate specialists for the management and control of the disease before performing the surgery they choose together based on your specific situation. The disease does not contraindicate any particular bariatric procedure, but it can condition bariatric surgery if the patient's functional status is not acceptable to assume the surgical and anesthetic risk.
Speaking specifically of obstructive apnea and gastric sleeve, there are studies that confirm its effectiveness as a definitive but not immediate treatment of the disease since the weight loss is gradual and as the fatty deposits are reduced, the parameters of the pulmonary and sleep function get better, this improvement is observed during the first 3 to 6 months after surgery.
As you can see, obstructive sleep apnea is a serious illness which the patient often is not aware of its presence, however it represents a serious risk not only for the patient's health but also for the patient's life, this is why we try to make conscience between our readers to consider this as one of the many reasons that exist to justify the minimal risk represented by gastric sleeve surgery or another approved bariatric procedure.
Currently, obstructive sleep apnea is considered a parameter in itself that makes a patient eligible for bariatric surgery when their body mass index is 35 or higher.
Would you like to know what you should do to determine if you have obstructive sleep apnea? Contact us and we will explain what you should do for its diagnosis.