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Guggino J, Tamisier R, Betry C, Coumes S, Arvieux C, Wion N, Reche F, Pépin JL, Borel AL. Bariatric surgery short-term outcomes in patients with obstructive sleep apnoea: the Severe Obesity Outcome Network prospective cohort. Int J Obes (Lond) 2021; 45:2388-2395. [PMID: 34453099 DOI: 10.1038/s41366-021-00903-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Although the benefits of bariatric surgery have been clearly established, it is not known whether they are as important in patients with obstructive sleep apnoea (OSA). Primary aim: to evaluate whether patients with moderate-to-severe OSA (apnoea-hypopnea index (AHI) ≥ 15 events/h) treated by continuous positive airway pressure/non-invasive ventilation (median [IQR] adherence 6.5 h/night [5; 7.9] at baseline) lose the same amount of body weight 1 year after bariatric surgery as patients with no or mild OSA. Secondary objectives: to compare the evolution of type 2 diabetes and hypertension after bariatric surgery, and surgical complication rates between groups. METHODS/SUBJECTS Analyses were performed in 371 patients included in a prospective cohort of bariatric surgery, the Severe Obesity Outcome Network cohort. Subjects having moderate-to-severe OSA (n = 210) at baseline were compared with other subjects (n = 161). RESULTS Excess weight loss (%EWL) at 1 year was lower in patients with moderate-to-severe OSA than in patients without (64.9%EWL [46.9; 79.5] vs. 73.8%EWL [56.6; 89.3], p < 0.01). Multivariable analysis showed that age, initial body mass index and type of surgery, but not OSA status, were associated with 1-year %EWL. Diabetes remitted in 25 (41%) patients with moderate-to-severe OSA and 16 (48%) patients with no or mild OSA (p = 0.48). Hypertension remitted in 28 (32.9%) patients with moderate-to-severe OSA and 9 (40.9%) with no or mild (p = 0.48). Complication rates were 28 (13.3%) in patients with moderate-to-severe OSA and 12 (7.5%) in patients with no or mild OSA (p = 0.07). CONCLUSIONS Patients with OSA lose less body weight after bariatric surgery. This was related to older age and a higher baseline body mass index. However, the improvements of diabetes and hypertension were similar to that of patients without OSA, and the risk of surgical complications was not higher.
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Affiliation(s)
- Jessica Guggino
- Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France
| | - Renaud Tamisier
- Univ. Grenoble Alpes, Inserm, U1300, "Hypoxia-physiopathology" Laboratory, Grenoble Alpes University Hospital, "Pôle Thorax et Vaisseaux", Grenoble, France
| | - Cécile Betry
- Univ. Grenoble Alpes, "Translational Innovation in Medicine and Complexity" (TIMC) Laboratory, Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Grenoble, France
| | - Sandrine Coumes
- Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France
| | - Catherine Arvieux
- Univ. Grenoble Alpes, Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Nelly Wion
- Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France
| | - Fabian Reche
- Univ. Grenoble Alpes, "Translational Innovation in Medicine and Complexity" (TIMC) Laboratory, Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, Inserm, U1300, "Hypoxia-physiopathology" Laboratory, Grenoble Alpes University Hospital, "Pôle Thorax et Vaisseaux", Grenoble, France
| | - Anne-Laure Borel
- Univ. Grenoble Alpes, Inserm, U1300, "Hypoxia-physiopathology" Laboratory, Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France.
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Guggino J, Coumes S, Wion N, Reche F, Arvieux C, Borel AL. Effectiveness and Safety of Bariatric Surgery in Patients with End-Stage Chronic Kidney Disease or Kidney Transplant. Obesity (Silver Spring) 2020; 28:2290-2304. [PMID: 33230959 DOI: 10.1002/oby.23001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/25/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to evaluate (1) the effectiveness, complications, and postoperative access to transplantation in end-stage chronic kidney disease (ECKD) and (2) the effectiveness and complications of bariatric surgery in patients who had already undergone kidney transplant. METHODS A systematic review and meta-analysis of mortality and complications rates were performed. Thirty studies were reviewed. RESULTS After bariatric surgery, patients with ECKD had similar postoperative weight loss to patients from the general population. Meta-analysis showed post-bariatric surgery rates of 2% (95% CI: 0%-3%) for mortality and 7% (95% CI: 2%-14%) for complications. Approximately one-fifth of the patients had access to a transplant. This rate may be underestimated because of the short duration of follow-up. The lack of control groups did not allow for a conclusion on the role of bariatric surgery in facilitating access to kidney transplantation. In patients who had received a kidney transplant, bariatric surgery seemed to improve renal function but increased graft-rejection risk, possibly because of changes in the bioavailability of immunosuppressant drugs. CONCLUSIONS Bariatric surgery yields significant weight loss in patients with ECKD that improves patients' chances of accessing a transplant but does not guarantee it; however, the risk for complications and death is higher than in other patients. After transplantation, bariatric surgery-induced weight loss appeared to positively impact the function of the grafted kidney, but careful monitoring of immunosuppressant medications is required.
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Affiliation(s)
- Jessica Guggino
- Endocrinology, Diabetology, Nutrition, Grenoble Alpes University Hospital, Grenoble, France
| | - Sandrine Coumes
- Endocrinology, Diabetology, Nutrition, Grenoble Alpes University Hospital, Grenoble, France
| | - Nelly Wion
- Endocrinology, Diabetology, Nutrition, Grenoble Alpes University Hospital, Grenoble, France
| | - Fabian Reche
- Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
- CNRS, UMR 5525, TIMC-IMAG, Domaine de la Merci, Grenoble, France
| | - Catherine Arvieux
- Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Anne-Laure Borel
- Endocrinology, Diabetology, Nutrition, Grenoble Alpes University Hospital, Grenoble, France
- Hypoxia Pathophysiology (HP2) INSERM U1042, Grenoble Alpes University, Grenoble, France
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