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The well-trained bariatric surgeons and physicians at Cedars-Sinai Marina del Rey Hospital work towards providing you with an individualized treatment plan to resolve your problem of obstructive sleep apnea through weight loss. Our expert surgeons and their team ensure superior care for their patients throughout the course of treatment, during recovery, and post-recovery period of weight-loss surgery.
Obstructive sleep apnea (OSA) is a serious, sleep-related breathing disorder that involves a partial or total blockage of airflow in the upper airway, which occurs because of collapsing soft tissues in the back of the throat due to relaxed muscles during sleep. OSA most commonly happens when you are lying down on your back. The partial or complete halt in breathing lasts for about 10 seconds during sleep, but at times may persist for 1 minute or longer. This causes a sudden decrease in the blood oxygen saturation level. As a result, your brain responds to this lack of oxygen and alerts your body to awaken you from sleep and restore breathing.
Obesity is one of the most complicating factors that potentiate the development of OSA. Obese people have more thick tissues around the throat, which predisposes them to sleep apnea. The prevalence of OSA in obese individuals is found to be as high as 45%. OSA may occur in people of all ages but affects about 25% of men and 10% of women.
Initially, the treatment for OSA is the adjustment of the sleeping position, which means lying on your sides rather than on your back. By doing this, the soft tissues of your throat do not recede and thus resolves the breathing difficulty to some extent. If this method is ineffective, a specialized machine that pumps air gently through a mask worn while sleeping is recommended. This maintains the air pressure within the airway sufficiently high to prevent the collapse of the soft palate.
Weight loss is a most effective treatment option for overweight people with mild or moderate OSA as it resolves sleep-disordered breathing. The American Academy of Sleep Medicine recommends that weight loss should be advised to every patient with OSA even though other treatments are being used. Weight loss achieved through bariatric surgery can decrease the severity of OSA symptoms, and sometimes, may cure OSA completely. Bariatric surgery is indicated in patients with a body mass index (BMI) ≥ 35-40 and other co-morbidities. It can achieve a sustainable weight loss and is used as adjunctive treatment in OSA.
At Cedars-Sinai Marina del Rey Hospital, a weight loss surgery procedure is performed to observe significant improvement in OSA symptoms. As weight-loss or bariatric surgery is a major procedure, it is considered only when all the other conservative treatments for OSA fail to improve the condition.
Bariatric surgery may be performed using one of the following surgical techniques:
Our surgeons will decide on the type of procedure that best suits your needs.
Most often, our surgeons perform weight loss procedures using advanced laparoscopic (minimally invasive) techniques that have benefits such as lesser pain and scarring due to smaller incisions that facilitate quick recovery.
Laparoscopic Roux-en-Y Gastric Bypass
In this procedure, a smaller stomach pouch is created so that you can take in less amount of food. Then, your intestine is rerouted to connect the small stomach pouch to the lowermost segment of your small intestine. Generally, the recovery period is around 3-4 weeks after which you can return to work.
Laparoscopic Adjustable Gastric Banding (LAGB)
This technique involves the placement of an adjustable as well as inflatable band made of silicone material around the upper portion of your stomach. When adjusted in a proper way, it helps you restrict the food intake and control your hunger. The recovery is usually very quick and you can return to work in 1-2 weeks. The drawbacks involved in this procedure include the frequent need to adjust the band postoperatively, slippage of the band, and gastric prolapse, which requires a corrective surgical procedure.
Laparoscopic Sleeve Gastrectomy
This technique is a part of the staged approach followed to achieve surgical weight loss. It restricts the food intake by decreasing the size of your stomach. This approach is useful in patients with extremely high BMI, people with a heart or lung disorder, or individuals who cannot tolerate anesthesia and surgical procedures of longer duration. After the surgery, the recovery requires about 3-4 weeks. No frequent adjustments and postoperative visits are needed, which means the procedure is comparatively more compliant and efficacious.
A wide range of treatment strategies is used in OSA to achieve long-term success.
Generally, people who snore loudly or have difficulty in breathing during sleep suffer from Obstructive Sleep Apnea Syndrome (OSAS). This condition involves two basic types that are described below.
The problems with sleep quality develop slowly and may progress over some years, particularly when your weight increases at the same time. Most often, you may not recognize any symptoms as you fail to remember the sleep and wake cycles that occur during the night.
The following signs and symptoms indicate the presence of OSA.
Your doctor will inquire about your medical history, your behavior during the day and night sleep. During the physical examination, signs such as the presence of upper body obesity (higher BMI>3Okg/m2), wider neck circumference (more than 43 cm in men and 37 cm in women), abnormalities in the upper airways or soft palate, enlargement of the tonsils, and blood pressure will be checked for.
To evaluate your sleep behavior, a study called polysomnography may be advised. Polysomnography is an overnight sleep study performed at a sleep center, during which tiny sensors are attached to specific positions in your body to record brain waves, movements of your arms and legs, heart rhythm, respiratory rate, oxygen level, muscle activity, and other functions during sleep.
Sometimes, an X-ray or direct examination of your airways is performed to rule out any abnormalities in the throat.
Another type of study called Multiple Sleep Latency Test (MSLT) may be done during the day. In this test, you will be monitored through a nap lasting for 20 minutes, taken at every 2-hour intervals. This helps measure daytime sleepiness and other causes of sleepiness such as narcolepsy.
A major risk factor involved in the development of OSA is obesity. OSA is almost twice more common in obese and severely obese patients than individuals with a normal weight. Being overweight (BMI of 25 to 29.9) and obese (BMI of more than 30) can increase your risk of developing OSA.
Both waist and neck measurements are indicators of central obesity and are associated with an increased risk of OSA. Middle-aged or elderly men with central fat deposits and around the neck and postmenopausal women have increased deposits of visceral fat, thereby, are associated with a higher risk of OSA. Several other risk factors involved in the progression of OSA include:
The increased neck circumference and fat deposition surrounding the upper airway that occurs in obese individuals causes the narrowing of the air passages. Central or abdominal obesity is associated with reduced lung volumes, which increase the severity of sleep apnea. Increased collapsibility of the upper airways as a result of fat deposition is the main cause for the development of OSA in obese individuals.
The factors such as inactive lifestyle and increased food intake, especially refined carbohydrates are reasons for weight gain in patients with OSA. On the other hand, a hormone called ghrelin (produced by cells of the stomach lining) can stimulate appetite. The level of this hormone is elevated in obese individuals during the night, and further disturbed/reduced sleep increases the release of ghrelin. Eventually, increased appetite may lead to obesity.
You may also be advised alternative medical therapies as some of these can help in the treatment of sleep apnea caused by allergic conditions.
Alternative Systems of Medicine - Homeopathy
Certain homeopathic remedies that are used as supportive therapy for sleep apnea include Arsenicum album, Lachesis, Opium, Sambucus, Spongia, and Sulphur. The most appropriate remedy for your condition will be determined after evaluation by your homeopath.
Biologically based therapies - nutrition and herbal supplements
There is some evidence that a kind of acupuncture method called auriculotherapy acupoint pressure may be suggested in the treatment of sleep apnea.
The following preventive measures could help an obese person deal with or prevent the worsening of OSA:
If you are obese and suffering from symptoms of OSA, weight loss surgery could help in the remission of disorderly breathing during sleep. If you need any guidance, our surgeons at Marina Weight Loss can answer your questions and advise appropriate treatment.
Jeremy Korman, M.D., F.A.C.S.See Profile »
Mona Misra, M.D., FRCSC, FACS, FASMBSSee Profile »
Sean Rim, M.D.See Profile »
Atul Madan, M.D.See Profile »
Hooman Shabatian, M.D., M.S.See Profile »
Matthew Lublin, M.D.See Profile »
Sergey Lyass, M.D., FACSSee Profile »
Scott Cunneen, M.D.See Profile »
David Davtyan, M.D.See Profile »
Shahram Salimitari, M.D., M.S.See Profile »
Carson Liu , M.D.See Profile »
Mahbod Paya, M.D.See Profile »
Daniel Shouhed, M.D.See Profile »
Miguel Burch, M.D.See Profile »
Michael Feiz, M.D., F.AC.S.See Profile »
David A. Oliak, M.D.See Profile »