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Yang J, Qiao Y, Wu L, Wu Z. Sleeve Gastrectomy Surgery makes Obstructive Sleep Apnea Worse or Better?: a Multi-Center Observational Study in Patients with Obesity. Obes Surg 2024; 34:409-415. [PMID: 38165528 DOI: 10.1007/s11695-023-07031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Obstructive sleep apnea (OSA) is highly prevalent in the bariatric surgical population, with rates ranging from 50 to 70%. The impact of laparoscopic sleeve gastrectomy (LSG) on OSA and its associated risk factors remain relatively understudied. The aim of this study is to assess the effect of LSG on OSA and investigate predictors of new or worsening OSA postoperatively. Additionally, the study aims to provide evidence for the individualized selection of LSG procedures based on patient characteristics. METHODS This multi-center observational study enrolled 119 patients with obesity who underwent LSG and were subdivided into two groups based on their preoperative AHI: AHI < 15 and AHI ≥ 15. The patients were followed up and evaluated before and 30 days after LSG. The study utilized univariate and multivariate analyses to assess risk factors for postoperative AHI development. RESULTS Following LSG, there was a significant decrease in the mean AHI, leading to the resolution of OSA symptoms in 67.6% of patients with AHI ≥ 15. Neck circumference and the number of METS were also identified as independent risk factors for postoperative OSA. Furthermore, preoperative hypertension was found to be a significant predictor of new or worsened OSA after LSG. CONCLUSION LSG demonstrated effectiveness in improving OSA among patients with obesity. The study highlights the importance of preoperative hypertension evaluation and postoperative management in patients undergoing LSG. Further long-term, multicenter, and large-scale studies are recommended to validate and generalize these findings to diverse patient populations.
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Affiliation(s)
- Jingge Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China
| | - Yuhan Qiao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China
| | - Lina Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China.
| | - Zhenpeng Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, China
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Aung O, Amorim MR, Mendelowitz D, Polotsky VY. Revisiting the Role of Serotonin in Sleep-Disordered Breathing. Int J Mol Sci 2024; 25:1483. [PMID: 38338762 PMCID: PMC10855456 DOI: 10.3390/ijms25031483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Serotonin or 5-hydroxytryptamine (5-HT) is a ubiquitous neuro-modulator-transmitter that acts in the central nervous system, playing a major role in the control of breathing and other physiological functions. The midbrain, pons, and medulla regions contain several serotonergic nuclei with distinct physiological roles, including regulating the hypercapnic ventilatory response, upper airway patency, and sleep-wake states. Obesity is a major risk factor in the development of sleep-disordered breathing (SDB), such as obstructive sleep apnea (OSA), recurrent closure of the upper airway during sleep, and obesity hypoventilation syndrome (OHS), a condition characterized by daytime hypercapnia and hypoventilation during sleep. Approximately 936 million adults have OSA, and 32 million have OHS worldwide. 5-HT acts on 5-HT receptor subtypes that modulate neural control of breathing and upper airway patency. This article reviews the role of 5-HT in SDB and the current advances in 5-HT-targeted treatments for SDB.
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Affiliation(s)
- O Aung
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA; (O.A.); (M.R.A.)
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Anesthesiology and Critical Care Medicine, George Washington University, Washington, DC 20037, USA
| | - Mateus R. Amorim
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA; (O.A.); (M.R.A.)
- Department of Anesthesiology and Critical Care Medicine, George Washington University, Washington, DC 20037, USA
| | - David Mendelowitz
- Department of Pharmacology and Physiology, George Washington University, Washington, DC 20037, USA;
| | - Vsevolod Y. Polotsky
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA; (O.A.); (M.R.A.)
- Department of Anesthesiology and Critical Care Medicine, George Washington University, Washington, DC 20037, USA
- Department of Pharmacology and Physiology, George Washington University, Washington, DC 20037, USA;
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Dékány L, Molnár V, Molnár A, Bikov A, Lázár Z, Bárdos-Csenteri O, Benedek P. Analysis of possible risk factors for the severity of paediatric obstructive sleep apnoea syndrome. Eur Arch Otorhinolaryngol 2023; 280:5607-5614. [PMID: 37758856 PMCID: PMC10620301 DOI: 10.1007/s00405-023-08237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE This study aimed to determine the effect of body mass index (BMI) percentile, asthma, sex, and age on the paediatric obstructive sleep apnoea (OSA) severity. Furthermore, to determine the possible predictive role of the BMI percentile and age in severe OSA. METHODS This retrospective study included 921 children aged 2-18 years diagnosed with OSA by polysomnography. Analysis of Covariance (ANCOVA), Spearman's correlation, Receiver Operating Characteristics (ROC) analyses were performed and area under the curve (AUC) was determined. RESULTS We observed a significant association between a higher BMI percentile and the severity of OSA (p < 0.001, ρ = 0.15). The correlation also was significant under (p = 0.007, ρ = 0.11) and over 7 (p = 0.0002, ρ = 0.23) years of age. There was no association between the severity of OSA and the presence of asthma (p = 0.9) or sex (p = 0.891), respectively. Age was significantly related to OSA severity (p = 0.01, ρ = 0.08). Although both the BMI percentile (0.59 AUC [0.54-0.65]) and age (0.58 AUC [0.52-0.63]) predicted severe OSA, according to the sensitivity and specificity values of the ROC curve, the association presents a slight clinical relevance. CONCLUSIONS OSA severity is determined by the BMI percentile and age in children; however, these factors are unsuitable for predicting severe OSA in clinical practice. Based on our results, obesity is also a significant risk factor for OSA in younger children. Our study highlights that older, overweight, and obese children have a higher risk for severe OSA.
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Affiliation(s)
- Lea Dékány
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Viktória Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary.
| | - András Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - András Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zsófia Lázár
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Pálma Benedek
- Sleep Laboratory and Sleep Surgery Unit, Heim Pál National Paediatric Institute, Budapest, Hungary
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Johnson ZJ, Lestrud SO, Hauck A. Current understanding of the role of sleep-disordered breathing in pediatric pulmonary hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Sharma AV, Padhya T, Nallu S. Management of Pediatric Obstructive Sleep Apnea After Failed Tonsillectomy and Adenoidectomy. Adv Pediatr 2022; 69:95-105. [PMID: 35985719 DOI: 10.1016/j.yapd.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pediatric obstructive sleep apnea (OSA) represents a different entity from its adult counterpart and therefore requires a different therapeutic approach. Adenotonsillectomy (AT) is the primary treatment of pediatric OSA, and evidence shows it is very effective. However, there is a growing understanding that residual OSA is common, and next steps for patients who fail primary AT are less certain. This article reviews current methods of evaluating and treating these complex patients.
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Affiliation(s)
- Abhay Varun Sharma
- Department of Otolaryngology Head and Neck Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Boulevard, MDC 73 Tampa, FL 33612, USA.
| | - Tapan Padhya
- Department of Otolaryngology Head and Neck Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Boulevard, MDC 73 Tampa, FL 33612, USA
| | - Sagarika Nallu
- USF Health Department of Pediatrics, Division of Neurology, 13101 Bruce B Downs Boulevard, Tampa, FL 33612, USA
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Moon SB, Hwang SJ, Baker S, Kim M, Sasse K, Koh SD, Sanders KM, Ward SM. Changes in interstitial cells and gastric excitability in a mouse model of sleeve gastrectomy. PLoS One 2022; 17:e0269909. [PMID: 35737727 PMCID: PMC9223402 DOI: 10.1371/journal.pone.0269909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Obesity is a critical risk factor of several life-threatening diseases and the prevalence in adults has dramatically increased over the past ten years. In the USA the age-adjusted prevalence of obesity in adults was 42.4%, i.e., with a body mass index (BMI, weight (kg)/height (m)2) that exceeds 30 kg/m2. Obese individuals are at the higher risk of obesity-related diseases, co-morbid conditions, lower quality of life, and increased mortality more than those in the normal BMI range i.e., 18.5–24.9 kg/m2. Surgical treatment continues to be the most efficient and scientifically successful treatment for obese patients. Sleeve gastrectomy or vertical sleeve gastrectomy (VSG) is a relatively new gastric procedure to reduce body weight but is now the most popular bariatric operation. To date there have been few studies examining the changes in the cellular components and pacemaker activity that occur in the gastric wall following VSG and whether normal gastric activity recovers following VSG. In the present study we used a murine model to investigate the chronological changes of gastric excitability including electrophysiological, molecular and morphological changes in the gastric musculature following VSG. There is a significant disruption in specialized interstitial cells of Cajal in the gastric antrum following sleeve gastrectomy. This is associated with a loss of gastric pacemaker activity and post-junctional neuroeffector responses. Over a 4-month recovery period there was a gradual return in interstitial cells of Cajal networks, pacemaker activity and neural responses. These data describe for the first time the changes in gastric interstitial cells of Cajal networks, pacemaker activity and neuroeffector responses and the time-dependent recovery of ICC networks and normalization of motor activity and neural responses following VSG.
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Affiliation(s)
- Suk Bae Moon
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Sung Jin Hwang
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Sal Baker
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Minkyung Kim
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Kent Sasse
- Sasse Surgical Associates, Reno, Nevada, United States of America
| | - Sang Don Koh
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Kenton M. Sanders
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Sean M. Ward
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
- * E-mail:
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Damian A, Gozal D. Innovations in the Treatment of Pediatric Obstructive Sleep Apnea. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:339-350. [PMID: 36217094 DOI: 10.1007/978-3-031-06413-5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Obstructive sleep apnea affects a large proportion of otherwise healthy children in the context of interactions between craniofacial elements, adenotonsillar hypertrophy and other anatomical factors, and neuromuscular reflexes of the upper airway. In light of the adverse consequences of sleep apnea, it is important not only to proceed with early diagnosis but also to implement adequate treatment that is guided by the pathophysiological determinants of the disease in each child. Here, we will describe the current standard of care approaches to the treatment of pediatric obstructive sleep apnea, and will also explore novel management strategies that should enable more personalized therapy in the near future.
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Affiliation(s)
- Allan Damian
- Department of Neurology, University of Missouri School of Medicine, Columbia, MO, USA
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA
| | - David Gozal
- Comprehensive Sleep Medicine Program, University of Missouri School of Medicine, Columbia, MO, USA.
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA.
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