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Endothelial Function of Patients with Morbid Obesity Submitted to Roux-en-Y Gastric Bypass With and Without Obstructive Sleep Apnea-Hypopnea Syndrome

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Abstract

Background

Obesity is associated with obstructive sleep apnea-hypopnea syndrome (OSA) and both induce endothelial dysfunction. However, the effect of OSA on endothelial function after bariatric surgery has not been investigated yet.

Objectives

This study aims to evaluate the impact of weight loss on endothelial function in patients with and without obstructive sleep apnea (OSA) in the first 6 months after bariatric surgery.

Setting

This study was conducted at a university hospital, in Brazil.

Methods

The sample consisted of 56 patients homogeneously divided into groups with and without OSA. All patients underwent Roux-en-Y gastric bypass (RYGB), and the diagnosis of OSA was performed by polysomnography. The patients were evaluated preoperatively and 6 months after surgery. The evaluations included anthropometric measures, electrical bioimpedance, clinical symptoms of OSA, and endothelial function (flow-mediated dilation). RYGB improved the anthropometric, bioimpedance, and endothelial function results in both groups.

Results

Patients presented a significant clinical improvement in OSA symptoms throughout the study. However, patients with OSA had an improvement in the endothelial function 2.5% lower (p < 0.001) than patients without APNEA syndrome.

Conclusion

This study demonstrates that the existence of OSA prior to bariatric surgery interferes in the improvement of endothelial function.

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Abbreviations

OSA:

obstructive sleep apnea-hypopnea syndrome

RYGB:

Roux-en-Y gastric bypass

FMD:

flow-mediated dilation

References

  1. Ashrafian H, Le Roux CW, Rowland SP, et al. Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures. Thorax. 2012;67:442–9.

    Article  PubMed  Google Scholar 

  2. Garvey JF, Pengo MF, Drakatos P, et al. Epidemiological aspects of obstructive sleep apnea. J Thorac Dis. 2015;7:920–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26101650

    PubMed Central  PubMed  Google Scholar 

  3. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:136–43. Available from: http://pats.atsjournals.org/cgi/doi/10.1513/pats.200709-155MG

    Article  PubMed  PubMed Central  Google Scholar 

  4. Neilan TG, Farhad H, Dodson JA, et al. Effect of sleep apnea and continuous positive airway pressure on cardiac structure and recurrence of atrial fibrillation. J Am Heart Assoc [Internet]. 2013;2:e000421. Available from: http://jaha.ahajournals.org/cgi/doi/10.1161/JAHA.113.000421

    Google Scholar 

  5. Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132:2253–71.

    Article  PubMed  Google Scholar 

  6. Maggard MA, Shugarman LR, Suttorp M, et al. Clinical guidelines meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:542–58.

    Article  Google Scholar 

  7. Sjostrom L, Lindroos A-K, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  8. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. Available from: http://www.bmj.com/cgi/doi/10.1136/bmj.f5934

    Article  PubMed  PubMed Central  Google Scholar 

  9. Owan T, Avelar E, Morley K, et al. Favorable changes in cardiac geometry and function following gastric bypass surgery: 2-year follow-up in the Utah obesity study. J Am Coll Cardiol. 2011;57:732–9. Elsevier Inc.; Available from:. https://doi.org/10.1016/j.jacc.2010.10.017.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Sjoström L, Narbro K, Sjoström D, et al. New England Journal. New Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  11. Vanhoutte PM, Tang EHC. Endothelium-dependent contractions: when a good guy turns bad! J Physiol. 2008;586:5295–304.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Poredos P, Jezovnik MK. Testing endothelial function and its clinical relevance. J Atheroscler Thromb. 2013;20:1–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22972428

    Article  CAS  PubMed  Google Scholar 

  13. Thijssen DHJ, Black MA, Pyke KE, et al. Assessment of flow-mediated dilation in humans: a methodological and physiological guideline. AJP Hear Circ Physiol. 2011;300:H2–12. Available from: http://ajpheart.physiology.org/cgi/doi/10.1152/ajpheart.00471.2010

    Article  CAS  Google Scholar 

  14. Xu Y, Arora RC, Hiebert BM, et al. Non-invasive endothelial function testing and the risk of adverse outcomes: a systematic review and meta-analysis. Eur Hear J Cardiovasc Imaging. 2014;15:736–46. Available from: https://academic.oup.com/ehjcimaging/article-lookup/doi/10.1093/ehjci/jet256

    Article  Google Scholar 

  15. Gokce N, Vita JA, Mcdonnell M, et al. Effect of medical and surgical weight loss on endothelial vasomotor function in obese patients. Am J Cardiol. 2005;95:266–8. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15642566

    Article  PubMed  Google Scholar 

  16. Azuma M, Chihara Y, Yoshimura C, et al. Association between endothelial function (assessed on reactive hyperemia peripheral arterial tonometry) and obstructive sleep apnea, visceral fat accumulation, and serum adiponectin. Circ J. 2015;79:1381–9. Available from: https://www.jstage.jst.go.jp/article/circj/79/6/79_CJ-14-1303/_article

    Article  CAS  PubMed  Google Scholar 

  17. Marshall NS, Wong KKH, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31:1079–85.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jelic S, Padeletti M, Kawut SM, et al. Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation. 2008;117:2270–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Chung S, Yoon I-Y, Shin Y-K, et al. Endothelial dysfunction and C-reactive protein in relation with the severity of obstructive sleep apnea syndrome. Sleep J Sleep Sleep Disord Res. 2007;30:997–1001. Available from: http://ezproxy.lib.uh.edu/login?url= http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2007-19285-008&site=ehost-live\n http://iyoon@snu.ac.kr

    Google Scholar 

  20. Itzhaki S, Lavie L, Pillar G, et al. Endothelial dysfunction in obstructive sleep apnea measured by peripheral arterial tone response in the finger to reactive hyperemia. Sleep. 2005;28:594–600.

    Article  PubMed  Google Scholar 

  21. Ashrafian H, Le Roux CW, Darzi A, et al. Effects of bariatric surgery on cardiovascular function. Circulation. 2008;118:2091–102.

    Article  PubMed  Google Scholar 

  22. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. J Am Med Assoc. 2004;292:1724–37.

    Article  CAS  Google Scholar 

  23. Sturm W, Tschoner A, Engl J, et al. Effect of bariatric surgery on both functional and structural measures of premature atherosclerosis. Eur Heart J. 2009;30:2038–43.

    Article  PubMed  Google Scholar 

  24. Oyama JI, Nagatomo D, Yoshioka G, et al. The relationship between neutrophil to lymphocyte ratio, endothelial function, and severity in patients with obstructive sleep apnea. J Cardiol. 2016;67:295–302. https://doi.org/10.1016/j.jjcc.2015.06.005.

    Article  PubMed  Google Scholar 

  25. Murray JW. Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res. 2000;9:5–11.

    Article  Google Scholar 

  26. Bertalazi AN, Fagones SC, Hoff LS, et al. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol. 2009;35:839–45.

    Article  Google Scholar 

  27. Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument psychiatric practice and research. Psychiatry Res. 1989;28:193–213.

    Article  CAS  PubMed  Google Scholar 

  28. Kushida C, Littner M, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28:499–521.

    Article  PubMed  Google Scholar 

  29. Epstein LJ, Kristo D, Strollo P, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263–76.

    PubMed  Google Scholar 

  30. Sateia MJ. International classification of sleep disorders-third edition highlights and modifications. Chest. 2014;146:1387–94. https://doi.org/10.1378/chest.14-0970.

    Article  PubMed  Google Scholar 

  31. Corretti MC, Anderson TJ, Benjamin EJ, et al. Guidelines for the ultrasound assessment of flow-mediated vasodilation of the brachial artery. J Am Coll Cardiol. 2002;39:257–65.

    Article  PubMed  Google Scholar 

  32. Cruz JM, Hauck M, Cardoso Pereira AP, et al. Effects of different therapeutic ultrasound waveforms on endothelial function in healthy volunteers: a randomized clinical trial. Ultrasound Med Biol. 2016;42:471–80. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0301562915005888

    Article  PubMed  Google Scholar 

  33. Quintas-Neves M, Preto J, Drummond M. Assessment of bariatric surgery efficacy on obstructive sleep apnea (OSA). Rev Port Pneumol. 2016;22:331–6.

    CAS  PubMed  Google Scholar 

  34. Simpson L, Mukherjee S, Mn C, et al. Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea. Sleep. 2010;33:467–74. Available from: http://ezproxy.usherbrooke.ca/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=105174268&site=ehost-live

    Article  PubMed  PubMed Central  Google Scholar 

  35. García G, Bunout D, Mella J, et al. Bariatric surgery decreases carotid intima-media thickness in obese subjects. Nutr Hosp. 2013;28:1102–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23889627

    PubMed  Google Scholar 

  36. Valenta I, Dilsizian V, Quercioli A, et al. Impact of obesity and bariatric surgery on metabolism and coronary circulatory function topical collection on nuclear cardiology. Curr Cardiol Rep. 2014;16:1–9.

    Article  Google Scholar 

  37. Heneghan HM, Meron-Eldar S, Brethauer SA, et al. Effect of bariatric surgery on cardiovascular risk profile. Am J Cardiol. Elsevier Inc. 2011;108:1499–507. https://doi.org/10.1016/j.amjcard.2011.06.076.

    Article  PubMed  Google Scholar 

  38. Kong D, Qin Z, Wang W, et al. Effect of obstructive sleep apnea on carotid artery intima media thickness related to inflammation. Clin Invest Med. 2017;40:E25–33.

    Article  PubMed  Google Scholar 

  39. Lavie L. Oxidative stress in obstructive sleep apnea and intermittent hypoxia - revisited - the bad ugly and good: implications to the heart and brain. Sleep Med Rev. 2015;20:27–45. Elsevier Ltd. Available from:. https://doi.org/10.1016/j.smrv.2014.07.003.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the Clínica de Cirurgia da Obesidade e do Aparelho Digestivo -Santa Maria/RS/BR; Serviço de Diagnóstico e Métodos Gráficos (HUSM) -Santa Maria/RS/BR.

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Authors and Affiliations

  1. Departamento de Fisioterapia e Reabilitação, Universidade Federal de Santa Maria, Santa Maria, Brazil

    Ana Cristina de Assunção Machado, Antonio Marcos Vargas da Silva & Luis Ulisses Signori

  2. Centro de Ciências da Saúde, Curso de Fisioterapia, Universidade Federal de Santa Maria – UFSM, Av. Roraima no. 1000, Cidade Universitária, Bairro Camobi, Santa Maria, RS, 97105-900, Brazil

    Ana Cristina de Assunção Machado

  3. Departamento de Cirurgia, Universidade Federal de Santa Maria, Santa Maria, Brazil

    Glauco da Costa Alvarez

  4. Programa de Pós-graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

    Claudio Corá Mottin

Authors
  1. Ana Cristina de Assunção Machado
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Correspondence to Ana Cristina de Assunção Machado.

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de Assunção Machado, A.C., da Silva, A.M.V., Signori, L.U. et al. Endothelial Function of Patients with Morbid Obesity Submitted to Roux-en-Y Gastric Bypass With and Without Obstructive Sleep Apnea-Hypopnea Syndrome. OBES SURG 28, 3595–3603 (2018). https://doi.org/10.1007/s11695-018-3403-9

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