Abstract
ObjectiveRoux-en-Y gastric bypass (RYGB) surgery is an effective type of weight loss management and may improve obesity-related obstructive sleep apnea (OSA). Obese subjects who meet the criteria for surgery with OSA were enrolled. We investigated the metabolomic effects of RYGB on OSA.MethodsClinical data, serum measurements including indices of glycolipid metabolism, and polysomnography (PSG) measurements were collected at baseline and 6 months after RYGB surgery. Metabolomic analysis was performed using ultra-performance liquid chromatography-mass spectrometry.ResultsA group of 37 patients with obesity, type 2 diabetes (T2DM) and suspected OSA were enrolled of which 27 were OSA subjects. After RYGB surgery, metabolic outcomes and sleep parameters were all significantly improved. The OSA remission group had lower valine, isoleucine, and C24:1(cis-15) levels, and higher trimethylamine N-oxide, hippurate, and indole-3-propionic acid levels after RYGB surgery. A combination of preoperative indices (age, apnea-hypopnea index (AHI), fasting C-peptide level, and hippurate level) predicted the RYGB effect size in obese patients with T2DM and OSA, with an area under receiver operating characteristic curve of 0.947, specificity of 82.4%, and sensitivity of 100%.ConclusionsRYGB surgery may significantly improve the metabolic status of patients with obesity, T2DM and OSA. A combination of preoperative indices (age, AHI, fasting C peptide level, and hippurate level) may be useful for predicting the effect size of RYGB in obese patients with T2DM and OSA. The mechanisms underlying OSA remission need to be explored.
Highlights
Obstructive sleep apnea (OSA) has a high prevalence and is characterized by recurrent episodes of upper airway obstruction during sleep
According to postoperative apnea-hypopnea index (AHI), OSA patients were divided into two subgroups: OSA remission and OSA nonremission
The aforementioned parameters were similar between the subgroups showing significant improvement in obesity and OSA severity, except that the postoperative AHI was > 5 events/h in the non-remission group (Table 2)
Summary
Obstructive sleep apnea (OSA) has a high prevalence and is characterized by recurrent episodes of upper airway obstruction during sleep. OSA increases all-cause mortality [1, 2] by further progression of pathological changes involving sympathetic activation, oxidative stress, inflammation, exaggerated negative intrathoracic pressure, insulin resistance, endothelial dysfunction, or other factors related to OSA such as excessive daytime sleepiness, obesity and lung disease [2, 3]. 120 million people are at high risk of OSA in China [5], which has a prevalence exceeding 5% [5]. These subjects are withstanding the adverse effects causing by OSA. OSA is a serious health problem and a socioeconomic issue [6, 7]
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