Evaluation of OSAS in Patients Planned Bariatric Surgery Who Has Morbid Obesity

Öz

Background: Before bariatric surgery, diagnosis of OSAS is vital for the prevention of both operative and postoperative complications. İn diagnosing of OSAS, polysomnography (PSG) is the gold-standard method, but it cannot be performed on all patients due to cost and time limitations. We aimed to determine the new predictive factors that we can use to identify patients on whom we will perform PSG.
Materials and Methods: Preoperative height, weight, body mass index (BMI), neutrophil-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet mass index (PMI), and platelet-lymphocyte ratio (PLR) of the patients were recorded. PSG was performed, and apnea-hypopnea indices (AHI) were determined. This process was repeated one year after the surgery.
Results: A laparoscopic sleeve gastrectomy (LSG) was performed in 57 patients. There were statistically significant differences regarding age, height, BMI, and PMI values between the patients with and without OSAS before surgery (P < 0.05). Also, statistically significant differences were detected in preoperative and postoperative BMI and PMI values of patients whose OSAS ultimately improved (P < 0.05).
Conclusions: LSG is an effective method to reduce weight and, therefore, to improve OSAS. Also, BMI and PMI parameters are the most important predictive values in predicting OSAS. PSG can be performed on selected patients based on predictive values.

Anahtar Kelimeler

• Obesity
• obstructive sleep apnea
• polysomnography
• bariatric surgery
• platelet mass index
• Obesity, obstructive sleep apnea, polysomnography, bariatric surgery, platelet mass index

Bariatrik Cerrahi Planlanan Morbid Obezli Hastaların OSAS Açısından Değerlendirilmesi

Öz

Amaç: Bariatrik cerrahi öncesi OUAS(Obstrüktif uyku apne sendromu) tanısı, hem operatif hem de postoperatif komplikasyonların önlenmesi için hayati önem taşımaktadır. Polisomnografi (PSG) OUAS tanısında altın standart yöntem olmasına rağmen maliyet ve zaman kısıtlılığı nedeniyle tüm hastalara uygulanamamaktadır. PSG uygulayacağımız hastaları belirlemek için kullanabileceğimiz yeni prediktif faktörleri belirlemeyi amaçladık. Gereç Ve Yöntem: Hastaların ameliyat öncesi boy, kilo, vücut kitle indeksi (VKİ), nötrofil-lenfosit oranı (NLO), ortalama trombosit hacmi (OTH), trombosit-lenfosit oranı (PLR) ve trombosit kitle indeksi (PKİ) kaydedildi. PSG yapıldı ve apne-hipopne indeksleri (AHİ) belirlendi. Bu işlem ameliyattan bir yıl sonra tekrarlandı. Sonuç: 57 hastaya laparoskopik sleeve gastrektomi (LSG) yapıldı. Ameliyat öncesi OUAS olan ve olmayan hastalar arasında yaş, boy, VKİ ve PMI değerleri istatistiksel olarak anlamlı derece farklıydı (P < 0.05). Ayrıca, OUAS'ı nihai olarak düzelen hastaların ameliyat öncesi ve sonrası BMI ve PMI değerlerinde istatistiksel olarak anlamlı farklılıklar tespit edildi (P < 0.05). LSG, ağırlığı azaltmak ve dolayısıyla OSAS'ı iyileştirmek için etkili bir yöntemdir. Ayrıca BMI ve PMI parametreleri OUAS'ı tahmin etmede en önemli prediktif değerlerdir. PSG, prediktif değerlere dayalı olarak seçilmiş hastalarda yapılabilir.

Anahtar Kelimeler

• obezite
• bariatrik cerrahi
• uyku apne sendromu
• polisomnografi
• platelet kitle indexi

Kaynakça

1. (1) Report of WHO consultation. World Health Organization technical report series Obesity: Preventing and Managing the Global Epidemic,2000.
2. (2) NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Pane.Ann Intern Med. 1991;15;115(12):956-61.
3. (3) Juodeikis Z, Brimas G. Long-term results after sleeve gastrectomy: A systematic review. Surg Obes Relat Dis. 2017;13:693-99.
4. (4) Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217-39.
5. (5) Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA.200,284(23):3015-21.
6. (6) Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A. Sleep apnea and sleep disruption in obese patients. Arch Intern Med 1994;154:1705-11.
7. (7) Göçmen H, Karadağ M. Obstrüktif uyku apnesi sendromu epidemiyolojisi. Turkiye Klinikleri J Surg Med Sci 2007;3:7-10.
8. (8) Demir AU. Obstrüktif uyku apne sendromu (OUAS) ve obezite. Hacettepe Tıp Dergisi 2007;38:177-93.

9. (9) Cephalometric Study of Posterior Airway Space in Patients Affected by Class II Occlusion and Treated with Orthognathic Surger De Ponte, Francesco Saverio; Brunelli, Alessandra; Marchetti, Emanuele; More Journal of Craniofacial Surgery. 10(3):252-259, May 1999.
10. (10) Varol E, Ozturk O, Gonca T, et all. Mean platelet volume is increased in patients with severe obstructive sleep apnea. Scand J Clin Lab Invest 2010;70(7):497-502.
11. (11) Song YJ, Kwon JH, Kim JY, Kim BY, Cho KI. The plateletto-lymphocyte ratio reflects the severity of obstructive sleep apnea syndrome and concurrent hypertension. Clinic Hypertens. 2016;22:1.
12. (12) Geiser T, Buck F, Meyer BJ, et al. In vivo platelet activation is increased during sleep in patients with obstructive sleep apnea syndrome. Respiration 2002;69:229-234.
13. (13) Hui DS, Ko FW, Fok JP, et al. The effects of nasal continuous positive airway pressure on platelet activation in obstructive sleep apnea syndrome. Chest 2004;125:1768-1775.
14. (14) N. Demir, E. Peker, I. Ece, K. Agengin, K.A. Bulan, O. Tuncer. Is platelet mass a more significant indicator than platelet count of closure of patent ductus arteriosus? J Matern Fetal Neonatal Med, 29 (2016), 915-1918
15. (15) American Academy of Sleep Medicine. The AASM Manualforthe Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester (Illinois, United States):American Academy of Sleep Medicine; 2007.
16. (16) Yazır Y, Gonca S, Fılız S, Dalçık H. An Important Protein Family for Endothelial Cells; Vascular Endothelial Growth Factor (Vegf) Members of the Family, Structure and Synthesis. C. Ü. Tıp Fakültesi Dergisi 26 (4):181 – 184, 2004
17. (17) Christensen RD. Platelet transfusion in the neonatal intensive care unit: Benefits, risks, alternatives. Neonatology 2011; 100:311–8.
18. (18) Gerday E, Baer VL, Lambert DK et al. Testing platelet mass versus platelet count to guide platelet transfusions in the neonatal intensive care unit. Transfusion 2009; 49: 2034–9.
19. (19) O'Keefe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg 2004;14:23-26.
20. (20) Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg 2003; 13: 676-83.
21. (21) Del Genio G, Limongelli P, Del Genio F et al. Sleeve gastrectomy improves obstructive sleep apnea syndrome (OSAS): 5 year longitudinal study. Surg Obes Relat Dis. 2016 Jan;12(1):70-4
22. (22) Sczepaniak, J.P., Owens, M.L., Shukla, H. et al. Comparability of Weight Loss Reporting After Gastric Bypass and Sleeve Gastrectomy Using BOLD Data 2008–2011. OBES SURG 25, 2015; 788–795.
23. (23) Rajala R, Partinen M, Sane T et al. Obstructive sleep apnoea syndrome in morbidly obese patients. J Intern Med 1991;230: 125-9.
24. (24) Dixon JB, Schachler LM, O'Brien PE. Sleep disturbance and obesity: changes following surgically induced weight loss. Arch Intern Med 2001; 161: 102-6.
25. (25) Varol E, Ozturk O, Gonca T, et all. Mean platelet volume is increased in patients with severe obstructive sleep apnea. Scand J Clin Lab Invest 2010;70(7):497-502.
26. (26) Sunbul M, Sunbul EA, Kanar B, Yanartas O, Aydin S, Bacak A. et al. The association of neutrophil to lymphocyte ratio with presence and severity of obstructive sleep apnea. Bratisl Lek Listy. 2015;116(11):654-8.