451 Change of sleep disordered breathing severity in obese patients receiving Laparoscopic sleeve gastrectomy

Abstract

Abstract Introduction Bariatric surgery via laparoscopic sleeve gastrectomy (LSG) was proved to alleviate significantly in apnea hypopnea index (AHI) in obesity patients. We aimed to investigate LSG effects on AHI in different sleep stage (REM vs NREM) and in position (supine vs non-supine) and on CO2 reduction and to identify the factors associated of AHI reduction. Methods From April 2016 to December 2020, 22 obese patients who underwent PSG before and after bariatric surgery at National Taiwan university Hospital were retrospectively studied. The simultaneously nocturnal percutaneous transcutaneous CO2 (PtcCO2) monitoring was applied. Demographic, anthropometric characteristics, Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), PSG parameters were reviewed. Responsive to treatment was defined as AHI reduction ≥50% and residual AHI< 10/hour. Results Postoperative PSG was performed in 22 patients [13 men and 9 women, median age 38 years (interquartile range, 32.8–46.5), median body mass index (BMI) 44.5 kg/m2 (39–52.5)] and median follow up days of 535 days (440–687) after LSG. The median post-op BMI was 32.4 kg/m2 (28.3–37.1). The AHI decreased from 51.9/h (27–85.9) to 10.7/h (2–16.3) (p<0.01). The AHINREM decreased from 49.9/h (31.8–91.5) to 5.8/h (1.1–17.3) while the AHIREM decreased from 63.7/h (52.5–83.2) to 19.6/h (4.4–49.7) /h. The AHIsupine decreased from 64.1/h (40.1–88.8) to 11.9/h (2.3–18.7) while the AHInon-supine decreased from 27.5 /h (17.6–78.3) to 1 /h (0–2). The average PtcCO2 decreased from 51.6 mmHg (39.3–54.7) to 46 mmHg (36.6–49.3) while %PtcCO2-total sleep time>50mmHg decreased from 84.5% (0.1–99.1) to 0% (0–44.6). Logistic regression showed baseline higher AHI was independently associated with less treatment responsive [odds ratio, 0.909 (0.84–0.985)]. Conclusion The AHI and PtcCO2 marked decreased via LSG where the residual AHI was lower in NREM than REM sleep; and in non-supine than supine. Baseline AHI is inversely associated with the residual AHI Support (if any) Ministry of Science and Technology (MOST 109-2314-B-002-252)