Sleep Apnea and Weight Loss

25965472 - female runner knee injury and pain. What is Sleep Apnea?
Sleep apnea is a serious chronic medical disorder where you stop breathing while asleep; depending on the severity, this may occur a few times a night or as many as several hundred, usually for about 10 seconds per incident. When this happens, your brain and body become oxygen deprived.

The three types of sleep apnea are:

Obstructive sleep apnea is induced by the collapse of your throat, which thereby obstructs your airways. You will usually be unaware of it unless another person is alerted by your snoring.

Central sleep apnea is caused by a neurological problem in which your brain fails to signal the muscles responsible for breathing. Generally, your snoring will awaken you.

Mixed sleep apnea is a combination of obstructive and central.

Symptoms of Sleep Apnea
When your brain and body are oxygen-deprived, there may be far-reaching negative consequences such as high blood pressure (hypertension), stroke, heart disease, abnormal heart rhythm, diabetes, gastroesophageal reflux disease (GERD), and others.

Signs that you may have sleep apnea include:

  • Loud, regular and disruptive snoring
  • Recurrent breaks in breathing, often following by choking or gasping
  • Fitful sleep
  • Daytime sleepiness
  • Irritability or depression
  • Waking with dry mouth and “sticky” front teeth
  • Morning headaches

Causes of Sleep Apnea
The most common cause of sleep apnea is excess body weight/obesity, generally defined as weighing more than 20% of your normal weight. According to the Centers for Disease Control (CDC), more than one-third of Americans are obese.

Other factors may include:

  • Severe acid reflux (GERD), generally seen in patients who are obese
  • Nighttime chest pain
  • Age, may cause loss of muscle tone
  • Enlarged tonsils or adenoids, usually seen in children
  • Smoking, irritates the throat, lungs, and esophagus
  • Frequent use of alcohol, relaxes the body’s muscles, including those of the throat
  • Genetics

How is Sleep Apnea Diagnosed?
An evaluation based on your signs and symptoms may be made, or your doctor may refer you to one or more specialists including ENT (eye, nose and throat), cardiologist (heart), neurologist (nervous system), and/or a sleep disorder center to determine the need for further evaluation.
Can Bariatric (Weight Loss) Surgery Cure Sleep Apnea?
For those overweight/obese, bariatric surgery is recognized as one of the most successful treatment alternatives, bringing about either total remission or marked decrease in symptoms.
What is Bariatric Surgery?
The purpose of bariatric surgery is to reduce the amount of your food intake by making you feel satisfied sooner, thus causing weight loss. Most bariatric surgeries are performed using laparoscopic (minimally invasive) techniques.

The most frequently used bariatric surgeries for sleep apnea include:

  • Laparoscopic adjustable gastric band
  • Gastric sleeve surgery (sleeve gastrectomy)
  • Gastric bypass, most commonly used
  • Biliopancreatic diversion with duodenal switch, used less often.

Laparoscopic Adjustable Gastric Band
A ring with an inner inflatable band is placed around the top of the stomach leaving only a small sac for food.

Gastric Sleeve
Most of the stomach is removed, save for a curved section that is stapled shut.

Gastric Bypass
In gastric bypass surgery, the stomach is stapled, and a smaller sac for food is formed in its upper section. Next, the small intestine is cut, and the lower part attached directly to the newly created sac, detouring food away from most of the stomach and upper part of the small intestine, limiting the absorption of calories.

Duodenal Switch
The duodenal switch involves two separate surgeries. The first is much like gastric sleeve surgery, while the second redirects food so that it avoids the larger part of the small intestine. The more complex of the three other surgeries, the duodenal switch allows for greater weight loss, but is more likely to produce surgery-related difficulties.
Risks Associated with Bariatric Surgery
Gastric bypass and other weight-loss surgeries present possible health risks, as do all major surgeries; these include both long and short-term complications.

Among the risks associated with bariatric surgery are:

  • Infection
  • Adverse effects of anesthesia
  • Excessive bleeding
  • Blood clots
  • Breathing or lung problems
  • Gastrointestinal leakage
  • Death, though rare

Longer term risks and complications, which vary depending on the type of surgery, are also possible, including:

  • Obstruction of the bowel
  • Dumping syndrome (rapid gastric emptying)
  • Hernias
  • Gallstones
  • Hypoglycemia, (low blood sugar)
  • Malnutrition
  • Stomach puncture
  • Ulcers
  • Death, rare

When Considering Bariatric Surgery
Your doctor may make an evaluation as to whether you are a candidate for bariatric surgery based on your signs and symptoms or may refer you to a sleep specialist in a sleep disorder center.

Discuss the risks and benefits, along with your expectations regarding your outcome with your physician. Your current health will influence the success of the procedure and your recovery.