title: Sleeve gastrectomy improves obstructive sleep apnea syndrome (OSAS): 5 year longitudinal study.
abstract: BACKGROUND
  Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obese patients. Evaluation of the specific effects of sleeve gastrectomy (SG) on upper airway function has not been reported. Given the possibility that some patients will not respond despite weight loss, no studies have investigated whether other mechanisms may be responsible for persistent OSAS after bariatric surgery.
  
  
  OBJECTIVE
  To evaluate by subjective and objective assessment the impact of SG on upper respiratory physiology in the long-term.
  
  
  METHODS
  University Hospital, Division of Bariatric and ENT Surgery, in Italy.
  
  
  METHODS
  Thirty-six consecutive patients with OSAS who underwent laparoscopic SG were prospectively enrolled. The effect of SG on respiratory function and OSAS was followed for 5 years.
  
  
  RESULTS
  All patients completed the 5-year follow-up. A significant (P<.001) improvement in modified Epworth Sleepiness Scale questionnaire (ESS) was obtained in 91.6% (33/36) of patients. The Apnea/Hypopnea index (AHI) improved in 80.6% (29/36) of patients after surgery (from 32.8 ± 1.7 to 5.8 ± 1.2 (P<.001), 4.9 ± 1.7). The remaining 19.4% (7/36) of patients with a positive ESS and/or AHI all had an associated respiratory resistance due to nasal obstructive diseases.
  
  
  CONCLUSIONS
  SG improved OSAS overall, but patients who did not improve or only partially improved despite weight loss were found to have an associated nasal responsible pathology. How these patients will respond to nasal surgery and whether a 2-step procedure should be recommended for OSAS patients requires further study.
authors: Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy. Electronic address: gianmattia.delgenio@unina2.it.
authors: Gianmattia
authors: G
authors: Del Genio
authors: Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy.
authors: Paolo
authors: P
authors: Limongelli
authors: Center of Esophago-gastric and Bariatric Surgery, Clinica C.G. Ruesch, Naples, Italy.
authors: Federica
authors: F
authors: Del Genio
authors: Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology, Head and Neck Surgery Unit, Second University of Naples, Naples, Italy.
authors: Gaetano
authors: G
authors: Motta
authors: Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy.
authors: Ludovico
authors: L
authors: Docimo
authors: Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology, Head and Neck Surgery Unit, Second University of Naples, Naples, Italy.
authors: Domenico
authors: D
authors: Testa
mesh_terms: D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D017286:Polysomnography; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D013997:Time Factors; D055815:Young Adult
keywords: Bariatric surgery; ENT; OSAS; Polysomnography; Sleeve gastrectomy