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Changes Following Surgically Induced Weight Loss

John B. Dixon, MBBS, FRACGP; Linda M. Schachter, MBBS, FRACP; Paul E. O'Brien, MD, FRACS

Arch Intern Med. 2001;161:102-106.

Background  Obesity causes sleep disturbance and is the most significant risk factor for sleep apnea. Only surgical methods provide substantial sustained weight loss for most severely obese subjects.

Objective  To study sleep disturbance in patients undergoing laparoscopic adjustable gastric banding with a commercially available product (Lap-Band).

Methods  In this study, 313 consecutive patients with severe obesity (body mass index [calculated as weight in kilograms divided by the square of height in meters] >35) completed a preoperative sleep questionnaire and clinical assessment. One hundred twenty-three patients completed the same assessment 12 months after surgery. The characteristics of sleep disturbance and changes in responses to weight loss have been assessed.

Results  There was a high prevalence of significantly disturbed sleep in men (59%) and women (45%), with women less likely to have had their sleep disturbance investigated. Observed sleep apnea was more common in men, but daytime sleepiness was not affected by sex. Waist circumference was the best clinical measure predicting observed sleep apnea (R = 0.36; P<.001). The group lost an average of 48% (SD, 16%) of excess weight by 12 months. There was a significant improvement in the responses to all questions at follow-up, with habitual snoring reduced to 14% (preoperative value, 82%), observed sleep apnea to 2% (preoperative value, 33%), abnormal daytime sleepiness to 4% (preoperative value, 39%), and poor sleep quality to 2% (preoperative value, 39%) (P<.001 for all).

Conclusions  Obesity-related sleep disorders improve markedly with weight loss. Sustainable weight loss should be a primary aim in the management of severely obese patients with significant sleep disturbance, including sleep apnea. Low-risk laparoscopic obesity surgery should be considered for selected patients with this important comorbidity.

From the Department of Surgery, Monash University–Alfred Hospital (Drs Dixon and O'Brien), and the Department of Respiratory Medicine, Austin and Repatriation Medical Center (Dr Schachter), Melbourne, Australia.

Corresponding author: John B. Dixon, MBBS, FRACGP, Department of Surgery, Monash University–Alfred Hospital, Melbourne 3181, Victoria, Australia (e-mail: john.dixon{at}med.monash.edu.au).

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