Obstructive sleep apnea syndrome in morbid obesity - Effects of intragastric balloon
Obstructive sleep apnea syndrome in morbid obesity - Effects of intragastric balloon
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DOI：
10.1378/chest.128.2.618
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发表时间：
2005-08-01
期刊：
影响因子：
9.6
通讯作者：
Vianello, A
中科院分区：
文献类型：
--
作者：
Busetto, L;Enzi, G;Vianello, A
研究目的：在肥胖患者中，阻塞性睡眠呼吸暂停综合征（OSAS）是由于咽周脂肪沉积导致咽横截面积减少。体重减轻对肥胖受试者上呼吸道大小的影响仍然是未知的。我们分析了咽部横截面积的病态肥胖患者OSAS.Design，设置，和科目减肥前后：一组17名中年，病态肥胖的男性进行了评估，通过人体测量和心肺睡眠研究之前和之后的体重减轻插入胃内球囊。结果：基线时平均（+/- SD）体重指数为55.8 +/- 9.9 kg/m2，球囊取出时（插入后6个月）为48.6 +/- 11.2 kg/m2 [p < 0.001]。基线时，患者有内脏肥胖、大颈和重度OSAS。体重减轻与腰围的显著平均减少有关（分别为156.4 +/- 17.6 vs 136.7 +/- 18.4 em; p < 0.001），矢状腹径（分别为37.8 ± 3.0和32.3 ± 4.0 cm; p < 0.001）和颈围（分别为51.1 ± 3.7和47.9 ± 4.3 cm; p < 0.001）。此外，体重减轻导致OSAS几乎完全消退（呼吸暂停低通气指数分别为52.1 +/- 14.9 vs 14.0 +/- 12.4事件/h; p < 0.001）。在基线时，肥胖患者的咽横截面积显著低于20名非肥胖男性对照组，无论是在直立和仰卧位，在不同水平的咽。在肥胖患者中，胃内球囊定位引起的体重减轻与上气道通道尺寸的增加相关。体重减轻后，平均咽横截面积和声门水平的面积仍低于肥胖受试者比非肥胖受试者，然而，咽横截面积在口咽交界处是相似的两个group.Conclusions：病态肥胖的男性OSAS咽横截面积减少。在患有睡眠呼吸暂停的病态肥胖受试者中，体重减轻约15%的基线体重可显著增加咽横截面积并显著改善OSAS的严重程度。
Study objectives: In obese patients, obstructive sleep apnea syndrome (OSAS) is attributed to a reduction in pharyngeal cross-sectional area due to peripharyngeal fat deposition. The effect of weight loss on the size of the upper airways of obese subjects is still unknown. We analyzed the pharyngeal cross-sectional area before and after weight loss in morbidly obese patients with OSAS.Design, setting, and subjects: A group of 17 middle-aged, morbidly obese men was evaluated by anthropometry and cardiorespiratory sleep studies before and after weight loss obtained by insertion of an intragastric balloon. The pharyngeal cross-sectional area was measured by acoustic pharyngometry.Results: The mean (+/- SD) body mass index was 55.8 +/- 9.9 kg/m(2) at baseline and 48.6 +/- 11.2 kg/m(2) at the time of balloon removal (6 months after insertion) [p < 0.001]. At baseline, patients had visceral obesity, large necks, and severe OSAS. Weight loss was associated with a significant mean reduction of waist circumference (156.4 +/- 17.6 vs 136.7 +/- 18.4 em, respectively; p < 0.001), sagittal abdominal diameter (37.8 +/- 3.0 vs 32.3 +/- 4.0 cm, respectively; p < 0.001), and neck circumference (51.1 +/- 3.7 vs 47.9 +/- 4.3 cm, respectively; p < 0.001). Moreover, weight loss induced a nearly complete resolution of OSAS (apnea-hypopnea index, 52.1 +/- 14.9 vs 14.0 +/- 12.4 events/h, respectively; p < 0.001). At baseline, obese patients had significantly lower pharyngeal cross-sectional areas compared to a group of 20 nonobese male control subjects, both in the upright and supine position, at different levels of the pharynx. in obese patients, the weight loss induced by the positioning of the intragastric balloon was associated with an increase in the size of the upper airway passage. After weight loss, both the mean pharyngeal cross-sectional area and the area at glottis level were still lower in obese subjects than in nonobese subjects; however, the pharyngeal cross-sectional area at the oropharyngeal junction was similar in the two groups.Conclusions: Morbidly obese men with OSAS have a reduced pharyngeal cross-sectional area. A weight reduction of about 15% of baseline body weight may substantially increase the pharyngeal cross-sectional area and substantially improve the severity of OSAS in morbidly obese subjects with sleep apnea.