title: Early improvement in obstructive sleep apnea and increase in orexin levels after bariatric surgery in adolescents and young adults.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) associated with obesity is known to improve after bariatric surgery, but little is known about early changes in this condition after surgery.
  
  
  OBJECTIVE
  To study the clinical course of OSA after bariatric surgery SETTING: Children's hospital in the United States METHODS: Adolescents and young adults with obstructive sleep apnea undergoing vertical sleeve gastrectomy (n = 6) or gastric bypass (n = 1) were enrolled in this prospective study. Participants underwent formal polysomnography before and at 3 and 5 weeks after bariatric surgery. Anthropometric measurements and assay for orexin and leptin were also performed at study visits. Thirty-one adolescents who underwent 2 polysomnography studies that were 4 weeks apart served as control patients.
  
  
  RESULTS
  Baseline mean (range) age of participants was 17.8 (15.4-20.7) years, 71% were male, with body mass index of 55.2 (41.3-61.6) kg/m2and had a median apnea hypopnea index (AHI) of 15.8 (7.1-23.8) events/hour. Differences in least-square means from longitudinal analysis did not show significant differences in AHI in the control group but showed significant postoperative decline in AHI relative to baseline. AHI declined postoperatively from baseline by 9.2 events/hour (95% confidence interval: 3.8 to 14.5) at 3 weeks (P = .002) and 9.1 events/hour (95% confidence interval: 3.8 to 14.5) at 5 weeks (P = .002); there was no significant change from 3 to 5 weeks in AHI. Leptin decreased and orexin levels increased significantly by 3 weeks postoperatively.
  
  
  CONCLUSIONS
  These observations suggest that OSA responds early and out of proportion to weight loss after metabolic and or bariatric surgery, thus weight independent factors may at least in part be responsible for early improvement in OSA postoperatively.
authors.affiliation: Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Sleep Disorders Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: Raouf.amin@cchmc.org.
authors.forename: Raouf
authors.initials: R
authors.lastname: Amin
authors.affiliation: Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Sleep Disorders Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Narong
authors.initials: N
authors.lastname: Simakajornboon
authors.affiliation: Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Szczesniak
authors.affiliation: Surgical Weight Loss Center for Teens, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Thomas
authors.initials: T
authors.lastname: Inge
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D005260:Female; D005743:Gastrectomy; D015390:Gastric Bypass; D006801:Humans; D020738:Leptin / Q000378:metabolism; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery; D000068797:Orexins / Q000378:metabolism*; D063766:Pediatric Obesity / Q000097:blood / Q000601:surgery; D017286:Polysomnography; D011182:Postoperative Care; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020738:Leptin; D000068797:Orexins
keywords: Leptin; Orexin; Polysomnography; Sleep apnea; Sleeve gastrectomy