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Abstract：
The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45-70%. However, weight loss obtained by bariatric surgery is not always associated with full remission of OSA, suggesting that other confounding factors are present. This article aims to review the current literature, focusing on factors that could predict the persistence of OSA after bariatric surgery. For this purpose, relevant studies of more than 50 patients that assessed pre- and post-operative presence and severity of OSA detected by poly(somno)graphy (PG/PSG) in bariatric populations were collected. Six retrospective and prospective studies were evaluated that included 1302 OSA patients, with a BMI range of 42.6 to 56 kg/m2, age range of 44.8 to 50.7 years, and percentage of women ranging from 45% to 91%. The studies were very heterogeneous regarding type of bariatric surgery, diagnostic criteria for OSA and OSA remission, and delay of OSA reassessment. OSA remission was observed in 26% to 76% of patients at 11-12 months post-surgery. Loss to follow-up was high in all studies, leading to a potential underestimation of OSA remission. Based on this limited sample of bariatric patients, age, pre-operative OSA severity, proportion of weight loss, and type 2 diabetes (T2D) were identified as factors associated with OSA persistence but the results were inconsistent between studies regarding the impact of age and the magnitude of weight loss. Several other factors may potentially lead to OSA persistence in the bariatric surgery population, such as fat distribution, ethnicity, anatomical predisposition, pathophysiological traits, supine position, and REM-predominant hypopnea and apnea. Further well-conducted multicentric prospective studies are needed to document the importance of these factors to achieve a better understanding of OSA persistence after bariatric surgery in obese patients.
摘要：
在减肥手术人群中，阻塞性睡眠呼吸暂停（OSA）的患病率估计为45-70％。然而,减肥手术获得的体重减轻并不总是与OSA的完全缓解有关，这表明存在其他混杂因素。本文旨在回顾当前的文献，重点关注可以预测减肥手术后OSA持续的因素。为此,我们收集了50多名患者的相关研究,这些研究评估了减重人群中通过poly(somno)grazing(PG/PSG)检测到的OSA术前和术后的存在和严重程度.评估了六项回顾性和前瞻性研究，包括1302例OSA患者，BMI范围为42.6至56kg/m2，年龄范围为44.8至50.7岁，女性比例从45%到91%不等。关于减肥手术类型的研究非常不同，OSA和OSA缓解的诊断标准，以及OSA重新评估的延迟。在术后11-12个月观察到26％至76％的患者OSA缓解。在所有研究中，随访失败率很高，导致OSA缓解的潜在低估。根据肥胖患者的有限样本，年龄,术前OSA严重程度,减肥比例，和2型糖尿病(T2D)被确定为与OSA持续相关的因素,但关于年龄和体重减轻程度的影响的研究结果不一致.其他几个因素可能导致肥胖手术人群OSA持续存在，比如脂肪分布，种族,解剖学倾向,病理生理特征，仰卧位,和REM-主导的低通气和呼吸暂停。需要进一步进行良好的多中心前瞻性研究来记录这些因素的重要性，以更好地了解肥胖患者减肥手术后OSA的持久性。
