Long-term effects of gastric surgery for treating respiratory insufficiency of o
Am J Clin Nutr 1992 Feb;55(2 Suppl):597S-601S
Long-term effects of gastric surgery for treating respiratory
insufficiency of obesity.
Sugerman HJ, Fairman RP, Sood RK, Engle K, Wolfe L, Kellum JM
Department of Surgery, Medical College of Virginia, Richmond 23298.
The Pickwickian syndrome can be divided into two primary breathing
disorders, which can affect patients alone or in combination: sleep
apnea syndrome (SAS) and obesity hypoventilation syndrome (OHS).
Between 1980 and 1990, 126 patients with respiratory insufficiency
underwent gastric surgery for morbid obesity, 12.5% of the entire
series. These patients weighed more (164 +/- 36 vs 135 +/- 25 kg, P
less than 0.0001) and were more often men (62% vs 14%, P less than
0.001) than those without pulmonary dysfunction. Sixteen had OHS
alone, 65 had SAS alone, and 45 had both. Of those with OHS, 38 have
been followed for 5.8 +/- 2.4 y since surgery and 29 are currently
asymptomatic. In the 12 patients in whom arterial blood gases were
available greater than 5 y since surgery, the PaO2 increased from 54
+/- 10 to 68 +/- 20 mm Hg (P less than 0.0001) and PaCO2 fell from 53
+/- 9 to 47 +/- 11 mm Hg (P = 0.05). Of the 110 patients with SAS, 57
were available for follow-up an average of 4.5 +/- 2.3 y since
surgery and 38 were completely asymptomatic, 15 had mild SAS, and 4
had both SAS and OHS. In 40 patients with pre- and post-weight
reduction sleep polysomnograms, the sleep apnea index fell from 64 +/-
39 to 26 +/- 26 (P less than 0.0001). Although respiratory
insufficiency of obesity patients had a higher operative mortality
than did patients without pulmonary dysfunction (2.4% vs 0.2% after
gastric bypass), weight loss was associated with significant
improvements in sleep apnea, arterial blood gases, pulmonary
hypertension, left ventricular dysfunction, lung volumes, and
polycythemia.
Am J Clin Nutr 1992 Feb;55(2 Suppl):594S-596S
Bariatric surgery in morbidly obese sleep-apnea patients: short- and
long-term follow-up.
Charuzi I, Lavie P, Peiser J, Peled R
Department of Surgery C, Soroka Medical Center, Beer-Sheva, Israel.
Forty-seven obese sleep-apnea patients were investigated in the sleep
laboratory before and after a massive weight reduction achieved by
bariatric surgery. The first postoperative sleep investigations were
performed approximately 1 y after surgery and revealed a highly
significant decrease in the number of apneic episodes per hour of
sleep and a significant improvement in all sleep-quality-related
measures. A second postoperative sleep study was performed
approximately 7 y postoperatively and revealed that regaining of
weight was associated with the reappearance of sleep apnea syndrome,
although the great majority of the patients still felt, subjectively,
that they were well and did not suffer from recurrence of the sleep
apnea syndrome
