As part of my sleep medicine practice I see a good number of patients in consultation who are in the pre-operative stages of bariatric surgery. Given that obstructive sleep apnea (OSA) is most common in overweight patients, it is no surprise that there are a good number of bariatric patients that suffer from this disease.
The most common symptoms of sleep apnea (although you do not NEED to have them all to suffer from OSA) are significant and life altering daytime sleepiness, snoring with or without bed-partner reports of stopping breathing, dry mouth in the morning, headache on awakening you did not go to sleep with, waking up gasping for air occasionally, mental “foggyness” particularly in the morning, waking up feeling as if you did not sleep at all, among others.
So if OSA is associated with obesity, and you are about to lose a bunch of weight with bariatric surgery, why worry about it? Well, there are several very good reasons.
1) First of all is just the practical side of being put under anesthesia. Sleep apnea occurs when your upper airway closes off intermittently while asleep leading to periods of not breathing. As you cycle at night into deeper stages of sleep, the chance of apneas rise as your body relaxes more. It makes sense that once the anesthesiologist sedates you, any propensity to have apneas will be brought to the surface. I know many anesthesiologists and trust me, they want to know if you are going to have problems breathing under sedation! Knowing beforehand that you have OSA allows them to plan accordingly in the post-operative period.
2) Bariatric surgery above all else is a procedure to improve your overall health by losing significant amounts of weight. In addition to your BMI, having OSA is a well recognized cardiac risk factor, and it can be greatly improved by significant weight loss. There is no guarantee that weight loss will “cure” your sleep apnea, but that’s #3!
3) Trust me, your insurance company does not care if you snore or are sleepy all the time, they are worried about how much money you could potentially cost them. OSA has been shown in countless clinical trials to increase your lifelong risk of heart attacks, strokes, and death. Given that each of these problems tend to be costly, you really want to know if you have OSA!
During your journey with bariatric surgery, it is very likely that you will lose a significant amount of weight depending on which procedure you undergo. It is important to understand that excess weight does not CAUSE OSA, it only affects the severity. If you have very mild OSA at a normal weight, it is likely you will have much more severe disease if you increase your weight by 25-30 pounds. This means that the opposite is true: as you lose weight it is likely that you will make your OSA better.
That being said, please do not ASSUME that by losing 75 pounds, you can forget about your sleep apnea. It is strongly recommended that once your surgeon feels comfortable you have achieved at least 75% of your overall weight loss, that you get a repeat sleep study to verify the status of your OSA. Untreated OSA increases your risk of dying of all causes by 30% during the span of your life. The key is that these statistics have very little to do with how “severe” your OSA is. When it comes to the life-threatening nature of OSA, it does not matter if it is mild, moderate or severe…it’s simply a matter of yes or no.
I hope this helps you understand the importance of both pre-operative diagnosis OSA in the bariatric process, but also the danger of making assumptions about your disease after weight loss. For any questions, I suggest visiting a board certified sleep specialist in your area.