Obezite Cerrahisi Hastalarında Obstrüktif Uyku Apne Sıklığı

Abstract

Amaç: Obezite, obstrüktif uyku apnesinin (OUA) en önemli risk faktörlerinden ve sonuçlarından biridir. Kilo verme ve pozitif hava yolu basıncı tedavisi OUA tedavisinde başlıca yaklaşımlardır. Bu çalışmada bariatrik cerrahi planlanan obezite hastalarında OUA prevalansının değerlendirilmesi amaçlandı. Yöntemler: Üniversite Hastanesi Obezite Merkezi'nde 2015 yılında bariatrik cerrahi adayı ardışık 141 hasta, uyku ile ilişkili solunum bozuklukları açısından ameliyat öncesi klinik olarak değerlendirildi. Tüm olgulara ameliyat öncesi polisomnografik inceleme önerildi. Bulgular: Yaş ortalaması 37±10 olan 141 obezite cerrahisi adayının 103'ü (%73) kadındı. Olguların ortalama vücut kitle indeksi 46,9±6,4 kg/m2 idi. OUA'nın majör semptomları değerlendirildiğinde; 119 (%84,4) hastada horlama, 63 (%44,7) hastada gündüz uyku hali ve 49 (%34,8) hastada tanıklı apne vardı. Polisomnografik değerlendirmeyi kabul eden hastaların %75,7 'sinde (84/111) AHİ>5/saat bulunması nedeniyle OUA saptandı. Polisomnografi yapılan olguların %24,3'ünde (27/111) OUA negatifdi, %29,7'sinde (33/111) hafif OSA, %17,1'inde (19/111) orta derecede OUA ve %28,8'inde (32/111) şiddetli OUA saptandı. AHİ ile yaş (p=0.003), boyun ve bel çapı (p<0.001) arasında pozitif, zorlu vital kapasite yüzdesi arasında negatif korelasyon (p<0.001) bulundu. Obezite cerrahisinden ortalama 9 ay sonra yapılan polisomnografik kontrollerde AHİ'de ortalama %41,2 iyileşme, VKİ'de ortalama %22,8 azalma gözlendi. Sonuç: Obezite cerrahisi adaylarında OUA prevalansı oldukça yüksek bulunmuştur. Obezite cerrahisi öncesi sadece semptomatik olgularda değil tüm olgularda polisomnografik inceleme yapılması gerektiği düşünülmektedir. Bariatrik cerrahi OSA'yı iyileştirmeye yardımcı olabilir.

Keywords

• obezite
• bariatrik cerrahi
• uyku apne
• CPAP tedavisi
• laparoskopik sleeve gastrektomi

The Prevalence of Obstructive Sleep Apnea in Bariatric Surgery Patients

Abstract

Objective: Obesity is one of the most important risk factors and also consequences of obstructive sleep apnea (OSA). Weight loss and positive airway pressure therapy are the main approaches in the treatment of OSA. In this study, it was aimed to evaluate the prevalence of OSA in obesity patients scheduled for bariatric surgery. Methods: In the University Hospital Obesity Center, 141 consecutive patients who were candidates for bariatric surgery in 2015 were clinically evaluated preoperatively for sleep-related respiratory disorders. Preoperative polysomnographic examination was recommended to all cases. Results: Of 141 bariatric surgery candidates with a mean age of 37±10 years, and 103 (73%) were female. The mean body mass index of the cases was 46.9±6.4 kg/m2. Among the major symptoms of OSA, snoring was present in 119 (84.4%), daytime sleepiness in 63 (44.7%) and witnessed apnea in 49 (34.8%) patients. OSA was detected because AHI>5/hour was found in 75.7% (84/111) of the patients who accepted the polysomnographic evaluation. 24.3% (27/111) of the cases who underwent polysomnography had non OSA, 29.7% (33/111) mild OSA, 17.1% (19/111) moderate OSA, and 28.8% (32 /111), severe OSA was detected. AHI was positively correlated with age (p=0.003), neck and waist diameter (p<0.001), and negatively correlated with percent of the forced vital capacity (p<0.001). In polysomnographic controls performed an average of 9 months after bariatric surgery, an average of 41.2% improvement in AHI was observed, compared to an average of 22.8% decrease in BMI. Conclusion: OSA prevalence was found to be very high in bariatric surgery candidates. It was thought that polysomnographic examination should be performed before bariatric surgery not only in symptomatic cases but also in all cases. Bariatric surgery can help improve OSA.

Keywords

• obesity
• bariatric surgery
• sleep apnea
• CPAP therapy
• laparoscopic sleeve gastrectomy

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