Can Sleep Apnea be Treated with Bariatric Surgery?

Bariatric surgery is one of the most effective treatments for obese people with an issue of sleep apnea. Being overweight can cause many health problems, including the ability to get a good night's sleep. With over half of Americans being diagnosed as overweight, bariatric surger and with one in four predicted to be severely obese (carrying 100 pounds or more of excess weight), it's time to talk about obesity and one of its most common comorbidities, sleep apnea. As it turns out, being obese is one of the most important risk factors for the development of sleep apnea. Wouldn't it make sense, then, that weight loss surgery would be a good treatment for obesity and sleep apnea? To answer that question, let's delve into what sleep apnea is, what factors lead to disrupted sleep, and how disordered breathing can be treated using one or more weight loss procedures. What Causes Sleep Apnea & What are the Effects? Obstructive sleep apnea is a serious sleep disorder that involves the occasional collapse of soft tissues around the throat. When this occurs during sleep, you stop breathing, an action known as apnea, which is where the common sleep condition got its name. People who are obese tend to have thicker tissue around the throat. The obese are more prone to sleep apnea because the diaphragm and chest muscles must work harder to keep your airway open during sleep. Without a fully open airway, you won't be able to breathe, which affects your blood pressure and blood oxygen levels. The closed airway eventually reopens, allowing you to resume breathing. You might wake up suddenly gasping for breath. Other sleep apnea sufferers jerk away suddenly as if from a bad dream. While it's good that you begin breathing again, it's not so good that you are constantly being jolted awake. Sleep apnea sufferers tend to experience decreased sleep quality. This can lead to a host of health problems, including reduced oxygen flow to vital organs. If left untreated, sleep apnea can lead to an increased risk of hypertension (high blood pressure) and heart rhythm irregularities. In extreme cases, sleep disorder can lead to heart attacks and strokes. This is where bariatric surgery comes into play. Getting diagnosed with sleep apnea counts as finding obesity-related comorbidity. Health insurance will sometimes cover bariatric surgery if the individual has a high BMI (40 or above) or a BMI of 35 with one or more comorbidities, such as sleep apnea. The Different Types of Sleep Apnea and How to Diagnose Them There are three types of sleep apnea. There is Obstructive Sleep Apnea (OSA), Central Sleep Apnea (CSA), and Mixed Sleep Apnea (MSA). OSA is the most common form of sleep apnea, where the blockage of your airway leads to interrupted breathing while asleep. OSA can be caused by weight gain, smoking, alcohol consumption, and an improper sleeping position. Central sleep apnea causes the brain to temporarily stop sending signals that control breathing during sleep. This condition is rare. It is usually caused by Parkinson's Disease, heart failure, kidney failure, and stroke. Mixed sleep apnea is a combination of OSA and CSA. The best way to identify which type of apnea you have is to visit a sleep specialist. A sleep specialist can administer an overnight test using a polysomnogram, which is a device that measures rapid eye movement, heart rate, and breathing while you're asleep. The test is designed to determine your level of sleep fitness and can also be used to diagnose sleep apnea. Is Sleep Apnea Reversible with Weight Loss Surgery? Back to our original question. Since sleep apnea is a weight-related ailment, doesn't it stand to reason that weight loss surgery should cure it altogether? Weight loss (bariatric) surgeries like gastric bypass and gastric sleeve can help you lose up to 80% of your excess weight. This, in turn, can treat sleep apnea. In fact, studies show that 78% of patients who seek out bariatric surgery may have obstructive sleep apnea. These patients are also more likely to have other comorbidities like hypertension and type 2 diabetes. In many of these cases, the OSA goes undetected. The condition goes undiagnosed even among the population of normal-weight individuals. As many as 20 million people in the United States have been diagnosed with sleep apnea. That amounts to 5% to 10% of all adults. Yet experts believe that up to 85% of nationwide cases have yet to be identified. Can Gastric Sleeve or Gastric Bypass Cure Sleep Apnea? After they diagnose you with sleep apnea following an overnight sleep study, weight loss surgery can begin. The good news is that bariatric surgeries like gastric sleeve and gastric bypass can prevent many of the long-term complications that we typically see in patients who experience constantly disrupted sleep. This means you can potentially avoid diabetes, congestive heart failure, or a full-blown heart attack by getting treatment for both obesity and sleep apnea. By having weight loss surgery and losing the weight, and subsequently treating sleep apnea, you might find yourself better prepared to go to work. Pilots and divers of big rigs won't feel like sleeping at the controls while doctors and nurses can put their total focus on the patients under their charge. Whatever you do for work, ridding your life of sleep apnea will mean a better night's rest and improved performance on the job. Will You Still Need a CPAP Machine After Bariatric Surgery? One traditional method for providing continuous airway pressure while sleeping is to use a CPAP machine. CPAP stands for continuous positive airway pressure. You should wear a mask over the nose and mouth as you settle down for sleep. A machine then blows clean air through a tube, into the mask, and then into your nose and mouth. This process helps you breathe easier during the night, allowing for more restful and rejuvenating sleep. The CPAP machine is quiet enough not to wake you, and the controls are adjustable, allowing you to tweak the air pressure according to a level that is both comfortable and sleep-inducing. While CPAP is a good treatment for OSA, using a machine cannot cure the condition. Weight loss surgery, on the other hand, can provide a lasting resolution for this debilitating sleep condition. Which Bariatric Surgery is Most Effective for Sleep Apnea? There are two common surgeries recommended by bariatric surgeons for the treatment of obesity and sleep apnea (along with other comorbidities like type 2 diabetes and hypertension). Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy (gastric sleeve) both involve changes to your stomach. Gastric bypass surgery is a tad different and involves your surgeon rerouting your digestive system. These procedures are safe, take around an hour, and the surgeon performs them laparoscopically, which makes them minimally invasive techniques. There are several advantages to having your bariatric surgeon perform the surgery using a laparoscopic camera and other tools. There is less anesthesia and fewer and tinier incisions, which cuts down on recovery time, makes for less scarring, and allows for faster healing. Laparoscopic Gastric Bypass (Roux-en-Y) Gastric bypass requires incisions that are less than an inch long. The laparoscopic tools enter these points of access, whereby your surgeon manipulates them robotically. The surgeon will not cut you open like open-heart surgery, which means that all of the action takes place inside your abdomen. Your surgeon is able to control the tools using a monitor positioned nearby. In a skilled pair of surgeon's hands, gastric bypass surgery is safe and effective for significant weight loss. The Gastric Bypass Procedure Gastric bypass begins with the removal of 80% of your stomach tissue. The remaining tissue is formed into a pouch that limits the amount of food you can eat. The upper stomach is then rerouted to the small intestine, which bypasses the lower stomach, and allows for controlled digestion. Hormonal changes also occur as a result of surgery, which makes you feel less hungry, and fuller faster during meals. Gastric bypass has been shown to help patients lose 60% to 80% of their excess weight. And gastric bypass has been shown to be an effective treatment for sleep apnea. Gastric Sleeve Surgery Laparoscopic Sleeve Gastrectomy (LSG) begins the same way as gastric bypass, with the removal of 80% of your stomach. The remaining tissue is formed into a small pouch. This pouch resembles a banana and is sometimes called a sleeve, which gives this bariatric technique its unique name. The gastric sleeve is considered a constrictive bariatric technique, which means it limits your consumption of food. For some patients, a gastric sleeve is enough to help them lose a significant amount of their excess weight. For those with severe obesity, and heart and lung problems, the gastric sleeve may be only one stage among several in their weight loss journey. The surgeon can easily convert gastric sleeves to gastric bypass once the patient has lost enough weight to make for a healthier procedure. There is also the gastric band or Lap Band, though the laparoscopic band is falling out of favor. The reason is that the band is prone to slippage and other problems, which may lead to the need for a bariatric revision. Many surgeons are instead turning to more reliable surgeries such as gastric bypass or gastric sleeve. Gastric sleeve is considered a low-risk surgery and is quickly becoming the most common bariatric surgery due to its safety, reduced downtime compared to gastric bypass, and its ability to provide patients with long-term weight loss success. Gastric sleeve is also a viable treatment for sleep apnea. How Long Until Gastric Surgery Works at Treating Sleep Apnea? Undergoing weight loss surgery is an exciting time. You get to envision all the weight you are going to lose. Weight loss surgery helps you lose weight by restricting your food and making you feel less hungry. Bariatric surgery is not a magic pill, however. You must make good food choices and exercise to help the pounds come off. If you can manage to follow your surgeon's recommendations, the weight tends to come off fast. Bariatric patients tend to lose between 50% to 80% of their excess body weight within the first two years. As the weight comes off, the hope is that the fatty tissue around the throat will diminish also. The goal is to prevent you from experiencing the upper airway collapse that previously led to your sleep apnea issues. By carrying less excess weight, you'll breathe easier, and sleep better. Studies also show that sleeping more restfully at night is one of the key methods for losing weight. By undergoing weight loss surgery for obesity and sleep apnea, you're doing a very good thing for your health and quality of life. Will Insurance Cover the Weight Loss Surgery Procedure? Health insurance coverage is designed for life-saving treatments and medical procedures that will provide you with a better quality of life. Bariatric surgery definitely counts as both a lifesaving treatment and one that can boost your life in a number of interesting ways. Therefore, chances are good that insurance providers will pick up some or all of the tab of your procedure if you get a proper diagnosis for sleep apnea, and one for obesity. Your experience may vary depending on your insurance provider and the health policy you hold. Schedule a Consultation with Los Angeles Bariatric Surgeon Dr. Babak Moeinolmolki Dr. Babak Moeinolmolki performs gastric sleeve and gastric bypass surgery at Healthy Life Bariatrics in Los Angeles, California. Patients come from Glendale, Encino, and throughout Los Angeles (and sometimes from all over the world) to undergo bariatric surgery under the doctor's skilled care. Dr. Moeinolmolki specializes in minimally invasive surgeries like the gastric sleeve and bypass, which can treat your obesity and sleep apnea. Schedule a consultation with Dr. Moeinolmolki by calling his specialized surgical center, Healthy Life Bariatrics, your local source for healthy and rapid surgical weight loss. Call to discuss a time that works best for you (310)861-7844. Dr. Babak Moeinolmolki May 3, 2021