Association of Metabolic Syndrome With Prevalence of Obstructive Sleep Apnea and Remission After Sleeve Gastrectomy.

Yufei Chen,Yifei Zhang,Weiqing Wang,Jiabin Jin,Ling Zhang,Lijia Chen,Shaoqian Zhao,Weiqiong Gu,Yingkai Sun,Jie Hong,Lingxia Ye

doi:10.3389/fphys.2021.650260

Abstract

Obesity is an important risk factor for metabolic syndrome and obstructive sleep apnea (OSA). Bariatric surgery has been shown to effectively reduce weight and obesity-related comorbidities. However, the prevalence and severity of OSA in obese patients with different baseline metabolic states and the improvements of OSA after bariatric surgery remain unknown. The main aims of this study were to ascertain the prevalence of OSA in young Chinese obese patients with different metabolic states and to evaluate their respective OSA remission after laparoscopic sleeve gastrectomy. We first performed a cross-sectional study involving 123 metabolically healthy obese patients and 200 metabolically unhealthy obese patients (who had the same age and BMI ranges) to estimate the prevalence of OSA at baseline. Then we performed a retrospective study, which was registered at ClinicalTrials.gov (ref. NCT02653430) of 67 patients who underwent laparoscopic sleeve gastrectomy to evaluate the remission of OSA. Metabolically healthy and unhealthy obese patients had similar apnea-hypopnea index levels (16.6 ± 22.0 vs. 16.7 ± 18.7 events/h, P = 0.512) and prevalence of OSA (66.7% vs. 69.0%, P = 0.662). Male sex, age, waist circumference and lower liver-to-spleen ratio were independent risk factors for OSA. After laparoscopic sleeve gastrectomy, no difference was found in the decrease in body mass index (BMI) change (10.8 ± 4.8 vs. 10.8 ± 3.0 kg/m2, P = 0.996) or the decrease in the apnea-hypopnea index (18.9 ± 24.6 vs. 17.0 ± 24.0 events/h, P = 0.800). The remission of moderate-to-severe OSA was observed in the MHO (36.3%; 54.5–18.2%, P = 0.125) and MUO (32.2%; 66.1–33.9%, P = 0.001) patients. These results suggest that, in patients with obesity, metabolic syndrome does not add extra risk for the prevalence or severity of OSA. Both metabolically healthy and unhealthy obese patients could benefit equally from laparoscopic sleeve gastrectomy in terms of weight loss and obstructive sleep apnea remission.

Highlights

MATERIALS AND METHODSThe prevalence of obesity has continued to rise in prevalence at a rapid rate over the past decades
Homeostasis model assessment-estimated insulin resistance index (HOMA-IR) and lipid levels were higher in the metabolically unhealthy obesity (MUO) group except for lowdensity lipoprotein cholesterol (LDL-C) (Table 1)
We analyzed the relationship between metabolic state and the prevalence of obstructive sleep apnea (OSA) in obese patients and their remission after laparoscopic sleeve gastrectomy

Summary

Introduction

MATERIALS AND METHODSThe prevalence of obesity has continued to rise in prevalence at a rapid rate over the past decades. It is well recognized that there is an obese phenotype that does not involve the typical metabolic disorders associated with obesity. This unique subset of obese individuals without metabolic syndromes (MetS) has been described as “benign obesity” or “metabolically healthy obesity (MHO).”. Previous reports of this special obesity phenotype mostly focused on the risk of allcause mortality, cardiovascular events, and diabetes, and the conclusions remain controversial. As for the impact of MetS on other obesity-related comorbidities, there remains a lack of evidence

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Conclusion