0999 A dramatic response to sleeve gastrectomy in a patient with severe obstructive sleep apnea

Abstract

Abstract Introduction Obesity is a well-established major, yet modifiable risk factor for the development of obstructive sleep apnea (OSA). Weight loss has consistently been associated with improvement in OSA severity. Here, we present a case of a patient with morbid obesity and severe OSA who underwent bariatric surgery, which resulted in complete resolution of sleep apnea. Report of case(s) A 31-year-old woman with a history of morbid obesity (body mass index (BMI) 54kg/m²) and diabetes mellitus was seen in the sleep disorders clinic with symptoms of loud snoring, gasp awakenings, fragmented sleep, and excessive daytime sleepiness with an Epworth sleepiness score (ESS) of 18. Polysomnography (PSG) demonstrated severe OSA with an apnea-hypopnea index (AHI) of 129/hr, mean arterial oxygen saturation (SaO2) of 85%, and nadir SaO2 of 52%. Continuous positive airway pressure (CPAP) was prescribed but never started. One year later, she returned requesting treatment for OSA as part of evaluation for bariatric surgery. A split-night PSG re-demonstrated severe OSA with AHI 60/hr and nadir SaO2 of 51% with 54% of total sleep time spent with SaO2 less than 88%, and a good response to CPAP 14cmH2O with residual AHI 4/hr. CPAP was started and she demonstrated excellent adherence on follow up. Three years lapsed before she returned to the sleep clinic. During this time, she had undergone a sleeve gastrectomy and was successful at losing 156lbs (achieving BMI 31kg/m²). She reported resolution of snoring and daytime sleepiness with ESS of 1. She stopped using CPAP six months after surgery and wished to be re-evaluated for OSA. Repeat PSG showed no evidence of OSA with AHI 1/hr and SaO2 nadir of 91%. Conclusion Bariatric surgery is considered the most effective treatment for obesity and is indicated for patients with BMI 35kg/m² or greater with comorbid OSA. Although observational and randomized studies of weight reduction surgery have shown improvement in OSA severity post-operatively and even cure in some cases, few patients exhibit the extreme reduction in AHI seen here, with complete resolution of OSA. This case serves as an important reminder that weight loss should be a priority when managing patients with OSA and excess body weight. Support (if any)