Can the slightly overweight stop apnea with weight loss?

[SleepingUgly]

Bariatric surgery is the most effective treatment for obstructive sleep apnea, causing remission in 80 to 85 percent of cases... Surgically induced weight loss can be a lasting resolution for sleep apnea.

http://clevelandclinicweightloss.com/im ... ochure.pdf

[chunkyfrog]

Just because losing excess weight may not help with apnea or its treatment is no reason to keep the weight on.

[kteague]

As usual in these conversations, the variability among individuals makes any rule subject to exceptions. Since the original topic was on slightly overweight people, I'm wondering if any of our data watchers have first hand stories of any changes in their pressure needs or AHI with losing say 20 pounds? Still wouldn't determine whether a person's OSA preceded the weight gain though. But even at that, the weight gain may have worsened it. I was going to suggest an experiment with some of us losing 20 pounds and reporting our data and got excited for a minute then realized the question was about the slightly overweight, not losing that amount of weight. I'm afraid I wouldn't qualify.

[BlackSpinner]

Bariatric surgery is the most effective treatment for obstructive sleep apnea, causing remission in 80 to 85 percent of cases... Surgically induced weight loss can be a lasting resolution for sleep apnea.

http://clevelandclinicweightloss.com/im ... ochure.pdf

The real stats, not pushed by a weight loss clinic, say 49%

[SleepingUgly]

Bariatric surgery is the most effective treatment for obstructive sleep apnea, causing remission in 80 to 85 percent of cases... Surgically induced weight loss can be a lasting resolution for sleep apnea.

http://clevelandclinicweightloss.com/im ... ochure.pdf

The real stats, not pushed by a weight loss clinic, say 49%

Are you talking about bariatric surgery? I don't know what your source is and whether it's accurate, but even a nearly 50% CURE of apnea, in addition to other health issues no doubt, is great, IMO.

[jnk]

Thanks for linking to that quote, SU.

I believe that many such sites overstate that thought based on old assumptions. Things often do look a bit better for a while afterward. There is often a lower AHI for a time, yes. But my opinion is that the more experienced experts do not consider bariatric surgery a longterm solution to the deeper mechanical issues of the airway for the moderate-to-severe, partly for the reasons I mention above and partly for other reasons.

Remember that for many docs, a reduction in AHI is considered by them to be a cure. But as we all know, the approaches that cut AHI in half for half the people do not take the place of CPAP for those who want to remain awake and energetic. Feeling better than before (but still too sleepy) is not the same as complete remission and a PSG showing no more sleep-breathing issues.

Here are some other recent takes related to the deeper issue, in my opinion:

. . . bariatric surgery is an effective way of helping obese people lose weight; however, it does not result in a significant improvement in obstructive sleep apnea (OSA), -- http://www.medicalnewstoday.com/articles/251355.php

. . . patients with significant obesity who demonstrated OSA with a high apnea-hypopnea index (AHI) were treated with bariatric surgery alone after refusal of nasal continuous positive airway pressure (CPAP) treatment. At approximately 3 years post-surgery, subjects demonstrated a significant drop in blood pressure measured at rest, improvement in sleepiness and fatigue visual analogue scales, but continued to complain of daytime sleepiness. Polysomnography in these subjects demonstrated relative improvement in AHI, but patients continued to have a significant number of respiratory events and episodes of flow limitation. -- http://file.scirp.org/Html/6-8202354_35791.htm

[jnk]

From my point of view, the statements of the clinic could be clarified this way . . .

Bariatric surgery is the most effective treatment for obstructive sleep apnea [this is a lie, as we all know; cpap is the most effective, but they meant surgical treatment], causing remission [meaning, 'making things better even just a little bit'] in 80 to 85 percent of cases... Surgically induced weight loss can be [meaning, may or may not be in any given case] a lasting resolution [meaning, good enough according to the way some choose to measure] for sleep apnea.

Bracketed material mine, not theirs, of course.

The point is, don't misread "remission" to mean "cure." In that medical context, it can mean to find temporary relief in the sense of relieveing the intensity of some symptoms. And some don't even get that from it.

[SleepingUgly]

For those interested in reading the whole thing, here's the article jnk is quoting from:

http://file.scirp.org/Html/6-8202354_35791.htm

It's a retrospective study of 17 patients who had bariatric surgery who were subsequently sent back to the lab due to complaints of sleepiness/fatigue.

There were some interesting points (in the portions of the article I read), but they aren't cutting and pasting well in here... Best to read it in the discussion section of the original article.

There have been controversies regarding obese patients who are found to also have OSA. Patients with obesity will have enlarged tongues due to fat deposits [7], and obstructive sleep apnea syndrome (OSAS) noted in these subjects can often be related to a secondary narrowing of the upper airway due to the fatty infiltration of the different soft tissue structures within the upper airway. As early as 1986, Jamieson, et al. had shown that overweight and obese patients had, in general, a wider oral-facial anatomy when compared to non-overweight OSA subjects [8]. This study suggested that obesity maoccur before development of any upper airway sleep disordered breathing in some patients.Many of the complications and co-morbidities associated with OSAS are also linked to obesity such as the association with insulin resistance [9] or the reported cognitive dysfunction with impairments of memory and attention [10-12].Controversy remains in linking certain cardio-vascular co-morbidities, particularly hypertension, to OSA independent of obesity [13]. Our study demonstrates that the sole treatment of obesity leads to both a significant decrease in OSA and hypertension in many subjects (Figure 1). These results were obtained without nasal CPAP intervention.Many of the studies emphasizing that cardio-vascular and metabolic abnormalities are related to OSA have been performed on subjects with a BMI of at least 28 kg/m2, which is the inferior limit of obesity as defined by the World Health Organization [14,15], Before attributeing specific co-morbidities to OSAS, more important attention must be paid to the isolated role of abnormal weight and the specific role of the adipocyte proliferation that is always associated with obesity. The peptides controlled by the hyperactive adipocytes in an overweight/ obese subject may explain, many of the co-morbidities attributed to OSA in overweight individuals.Our retrospective analysis shows that bariatric surgery is an approach that is successful in reducing OSA as demonstrated by PSG. It also shows that bariatric surgery significantly lowers blood pressure without nasal CPAP. The treatment of obesity alone has a significant impact on blood pressure, which is something well-known but not emphasized enough.When high BMI or obesity are present, positive changes such as decrease in blood pressure, obtained after usage of nasal CPAP or bi-level often are inappropriately considered as secondary evidence for the role of OSA in the onset of the initially recorded abnormal blood pressure: But obesity per se induces many cardio-vascular changes, including induction of high blood pressure (HBP), without having to evoke presence of OSA, furthermore PAP equipment deals not only with the upper airway but also with the chest-bellows problem related to overweight/obesity status, further limiting attribution of initially observed HBP to OSA.Greenberg, et al. reported a meta-analysis of the response to bariatric surgery and showed that that such treatment does not always completely relieve symptoms associated with abnormal breathing during sleep [16]. In the present study, there was a significant improvement compared to baseline in the VAS scores, but subjectively patients complained enough for their surgeons to request additional sleep evaluation. Several factors may be causing these residual sleep complaints. Subjects may still have consequences of their previous overweight status, since none of our subjects had a BMI below 25 kg/m2. Also, the effect known as “blunting of the arousal response” occurs with sleep fragmentation, and this blunting will lessen with a decrease in the frequency of sleep fragmentation [17]. As a result, patients with an improved BMI after surgery may paradoxically perceive more subjective sleep disruption as blunting of arousal response may not be as important as at baseline due to better sleep with simultaneous decrease in sleep fragmentation.

[jnk]

From an overview, to give an idea of what they consider "success":

A total of 69 studies with 13,900 patients were included. All the procedures achieved profound effects on OSA, as over 75 % of patients saw at least an improvement in their sleep apnea. -- http://www.ncbi.nlm.nih.gov/pubmed/23299507

Even some honest hospitals come right out and say it in plain English:

Patients should not expect a “cure” for sleep apnea after weight loss surgery, but many people see the symptoms of this potentially serious condition get significantly better regardless of which procedure they undergo. -- http://www.marinahospital.com/blog/is-s ... ss-surgery

I'm sorry to have played my part in derailing this topic. Obviously no one "slightly overweight" will get bariatric surgery. I only mentioned it as an aside as an example of the point I was making. Sorry about that.

[SleepingUgly]

From an overview, to give an idea of what they consider "success":

A total of 69 studies with 13,900 patients were included. All the procedures achieved profound effects on OSA, as over 75 % of patients saw at least an improvement in their sleep apnea. -- http://www.ncbi.nlm.nih.gov/pubmed/23299507

Here's the abstract from the study jnk is citing:

There is a strong relationship between obesity and the development of obstructive sleep apnea (OSA). Respectively, bariatric surgery is often touted as the most effective option for treating obesity and its comorbidities, including OSA. Nevertheless, there remains paucity of data in the literature of the comparison of all the specific types of bariatric surgery themselves. In an effort to answer this question, a systematic review was performed, to determine, of the available bariatric procedures [Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, or biliopancreatic diversion (BPD)], which procedures were the most efficacious in the treatment of OSA. A total of 69 studies with 13,900 patients were included. All the procedures achieved profound effects on OSA, as over 75 % of patients saw at least an improvement in their sleep apnea. BPD was the most successful procedure in improving or resolving OSA, with laparoscopic adjustable gastric banding being the least. In conclusion, bariatric surgery is a definitive treatment for obstructive sleep apnea, regardless of the specific type.

Even some honest hospitals come right out and say it in plain English:

Patients should not expect a “cure” for sleep apnea after weight loss surgery, but many people see the symptoms of this potentially serious condition get significantly better regardless of which procedure they undergo. -- http://www.marinahospital.com/blog/is-s ... ss-surgery

And here's the text from this second link:

Obesity can cause or aggravate many medical conditions. High blood pressure, diabetes, and orthopedic problems are among the best-known. Another potentially serious condition associated with obesity may be alleviated with surgery: sleep apnea.

What is Sleep Apnea?

Sleep apnea is when a sleeping person has abnormal pauses in breathing or breathes very shallowly. The most common cause is when the soft tissue in the throat collapses when the muscles relax during sleep. This obstructs the airway, which makes it more difficult for the person to breathe and can also cause snoring. Obesity is one factor that often contributes to obstructive sleep apnea.

Treatments for sleep apnea can vary. Many patients are issued masks to wear during sleep; these are connected to an air pump that gently circulates air into the patient's airway, making sure the throat stays open and breathing can proceed normally. Other treatments include medication and alternative methods. Surgery on the throat can also be performed.

If a patient who has sleep apnea is also obese, it is highly recommended that he or she lose weight. While obesity does not necessarily cause sleep apnea, like many disorders associated with obesity, including heart disease, stroke, high blood pressure, and diabetes, sleep apnea can be improved with weight loss.

In a 2004 study from the Journal of the American Medical Association, a team of researchers found that 80.4% of gastric bypass patients and 94.6% of lap-band patients experienced resolution of sleep apnea after surgery[1]. A recent review of gastric sleeve surgery found that 60% had their sleep apnea resolved[2]. Patients should not expect a “cure” for sleep apnea after weight loss surgery, but many people see the symptoms of this potentially serious condition get significantly better regardless of which procedure they undergo.

[jnk]

Thanks for including the info surrounding my quotes, SU.

That way it is your fair-use decision, not mine.

Hopefully everyone truly interested will go to the links and read it all, as well as the links in the articles themselves.

[Sheffey]

Those bariatric surgery promoters intentionally overlook the problem with narrow jaws, short jaws and high arched palates in modern humans.

They also have zero data on how many of their prospective patients had sleep apnea before they became obese.

[archangle]

Don't forget that bariatric surgery screws you up for the rest of your life. You can never eat normally again. It may literally be a life saver. Life may be better, but bariatric surgery should be a last resort. It's being oversold like it's a magic pill you take and the weight comes off without side effects.

If you're on CPAP already, try to adjust it to work for you. You may be able to solve your problems.

Stay on the CPAP and lose the weight. Maybe it will help the apnea. If not, it still has other benefits.

[DeadlySleep]

The OP says he weighs 170 lbs and 165 lbs would put him in normal BMI.

Now we have impassioned pleas urging him to stay away from bariatric surgery.

Let me be the lone dissenter and urge him to run out and get that bariatric surgery and lose that five lbs.

[SleepingUgly]

The OP says he weighs 170 lbs and 165 lbs would put him in normal BMI.

Now we have impassioned pleas urging him to stay away from bariatric surgery.

Let me be the lone dissenter and urge him to run out and get that bariatric surgery and lose that five lbs.

Clearly the OP is not obese. But generally speaking, I would be leery of those charts that tell you how much you can weigh and be "normal". I just looked up mine and it says at my height, my ideal weight is 133, with a range of 119 to 146. If I weighed 146, technically I would not be overweight, but let me tell you, I WOULD be overweight! Also, I've seen how these kinds of charts are deceiving when people with scrawny legs have HUGE bellies and they believe themselves to be 10 overweight per the chart. Uh, no, you're not 10 pounds overweight--you're an entire person in your belly overweight (and not a fetus).

I bet some of the problem with bariatric surgery and OSA is the same as for the rest of the body--too much loose skin/flesh after that dramatic a weight loss. But that's just a guess.