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Nathalie Demaeyer,1 Marie Bruyneel1,2 1Department of Pneumology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; 2Department of Pneumology, CHU Brugmann, Université Libre de Bruxelles, Brussels, BelgiumCorrespondence: Marie Bruyneel, Department of Pneumology, CHU Saint-Pierre, 322 rue haute, Brussels, 1000, Belgium, Tel +3225354219, Fax +3225353362, Email marie.bruyneel@stpierre-bru.beAbstract: The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45– 70%. However, weight loss obtained by bariatric surgery is not always associated with full remission of OSA, suggesting that other confounding factors are present. This article aims to review the current literature, focusing on factors that could predict the persistence of OSA after bariatric surgery. For this purpose, relevant studies of more than 50 patients that assessed pre- and post-operative presence and severity of OSA detected by poly(somno)graphy (PG/PSG) in bariatric populations were collected. Six retrospective and prospective studies were evaluated that included 1302 OSA patients, with a BMI range of 42.6 to 56 kg/m2, age range of 44.8 to 50.7 years, and percentage of women ranging from 45% to 91%. The studies were very heterogeneous regarding type of bariatric surgery, diagnostic criteria for OSA and OSA remission, and delay of OSA reassessment. OSA remission was observed in 26% to 76% of patients at 11– 12 months post-surgery. Loss to follow-up was high in all studies, leading to a potential underestimation of OSA remission. Based on this limited sample of bariatric patients, age, pre-operative OSA severity, proportion of weight loss, and type 2 diabetes (T2D) were identified as factors associated with OSA persistence but the results were inconsistent between studies regarding the impact of age and the magnitude of weight loss. Several other factors may potentially lead to OSA persistence in the bariatric surgery population, such as fat distribution, ethnicity, anatomical predisposition, pathophysiological traits, supine position, and REM-predominant hypopnea and apnea. Further well-conducted multicentric prospective studies are needed to document the importance of these factors to achieve a better understanding of OSA persistence after bariatric surgery in obese patients.Keywords: bariatric surgery, gastric sleeve, gastric bypass, obstructive sleep apnea, polygraphy, polysomnography |
