(17) Assessment of Anatomic Airway Changes in Obstructive Sleep Apnea Patients Post Bariatric Surgery

Thursday, September 15, 2022

1:30 PM – 3:00 PM CDT

Sample of analysis showing cross-sectional area at different airway levels

Sample of volumetric airway analysis

Presenting Author(s)

Kyle M. Baird, DDS, MD

Resident, Oral and Maxillofacial Surgery
Case Western Reserve University
South Euclid, Ohio, United States

Co-Author(s)

Faisal A. Quereshy, MD, DDS, FACS

Residency Program Director
Department of Oral and Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine
Cleveland, Ohio, United States
JS

Jaspreet Singh, DMD

Resident, Oral and Maxillofacial Surgery
Case Western Reserve University
Cleveland, Ohio, United States

Disclosure(s):

Kyle M. Baird, DDS, MD: No financial relationships to disclose

Faisal A. Quereshy, MD, DDS, FACS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Jaspreet Singh, DMD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Abstract: Obstructive sleep apnea (OSA) is known to cause adverse health-related effects, reduce quality of life, and is the most common sleep disordered respiratory disease. Obesity is a main risk factor for OSA and several studies have investigated the effect of surgical weight loss on OSA. Some of these studies have shown an improvement in the apnea-hypopnea index (AHI) in OSA patients following bariatric surgery, however the extent to which OSA improves is unclear. In their 2009 systematic review, Greenburg et. al. concluded that despite an improvement in AHI, most OSA patients still had moderately severe OSA and should not expect a cure from bariatric surgery. Furthermore, the anatomic airway changes that result from bariatric surgery are even more unclear. Very little research has specifically investigated the anatomic airway changes post bariatric surgery. Al-Jumaily et. al. included analysis of volumetric anatomic airway changes in their 2018 pilot study, however this study had a small sample size (10 patients) and only included women. Further research is necessary to determine if and to what extent bariatric surgery affects anatomic airway.

A prospective study of 55 patients undergoing bariatric surgery at University Hospitals Cleveland Medical Center (UH) is being conducted. Eligible participants are those patients ages 18 to 70 who are scheduled for weight-loss surgery and who have polysomnography (PSG) diagnosed OSA with an AHI of at least 10. Patients with known craniofacial deformities or a history of previous upper airway-modifying surgeries are excluded from the study. All bariatric surgery patients within the UH system undergo a pre-surgery PSG. Those with diagnosed OSA also have follow-up PSG once sufficient weight-loss is achieved, which is usually around 12 months post-operatively. In addition to these standard procedures, study participants receive CBCT 3D imaging of the upper airway within the month prior to surgery and again 12 months after surgery. Body mass index (BMI), AHI, and volumetric airway data, including upper airway volume and cross-sectional area, are being collected preoperatively and 12 months postoperatively. Volumetric airway analysis is conducted using Invivo imaging software. To prevent bias, images are de-identified prior to airway analysis.

Data is being compared between the two stages of the study (preoperatively and 12 months postoperatively). Continuous data will be summarized with means and standard deviations; count data will be summarized with frequencies and percentages. Paired-samples t tests are being used to examine changes in airway volumetric measurements between time points. Changes over time will be analyzed separately for different subgroups if relevant. Pearson or spearman correlations will be used to examine potential associations among outcomes.

So far 5 participants have completed both study visits with additional participants returning for follow-up visits each month. Preliminary results show a trend towards a reduction in AHI following surgery, with those participants losing more weight experiencing greater reductions in AHI. However, no participant has yet been cured of their OSA (defined as AHI < 5). There has also been a trend toward increased upper airway volume and area following surgery. However, these changes have been inconsistent, with some showing no airway changes despite improvements in AHI. The lack of airway change could possibly explain why many patients experience improvement in their OSA but fail to be cured. Additional results are still needed for statistical analysis and to draw more definitive conclusions.

1. Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med 2009;122:535-42.

2. Al-Jumaily, Ahmed M., et al. “A Pilot Study on the Biomechanical Assessment of Obstructive Sleep Apnea Pre and Post Bariatric Surgery.” Respiratory Physiology & Neurobiology, vol. 250, 2018, pp. 1–6., doi:10.1016/j.resp.2018.01.007.