Long-term effects of gastric surgery for treating respiratory insufficiency of obesity

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Abstract
The Pickwickian syndrome can be divided into two primary breathing disorders, which can affect patients alone or in combination: sleep apnea syndrome (SAS) and obesity hypoventilation syndrome (OHS). Between 1980 and 1990, 126 patients with respiratory insufficiency underwent gastric surgery for morbid obesity, 12.5% of the entire series. These patients weighed more (164 ± 36 vs 135 ± 25 kg, P < 0.0001) and were more often men (62% vs 14%, P < 0.001) than those without pulmonary dysfunction. Sixteen had OHS alone, 65 had SAS alone, and 45 had both. Of those with OHS, 38 have been followed for 5.8 ± 2.4 y since surgery and 29 are currently asymptomatic. In the 12 patients in whom arterial blood gases were available > 5 y since surgery, the PaO2 increased from 54 ± 10 to 68 ± 20 mm Hg (P < 0.0001) and PaCO2 fell from 53 ± 9 to 47 ± 11 mm Hg (P = 0.05). Of the 110 patients with SAS, 57 were available for follow-up an average of 4.5 ± 2.3 y since surgery and 38 were completely asymptomatic, 15 had mild SAS, and 4 had both SAS and OHS. In 40 patients with pre- and post-weight reduction sleep polysomnograms, the sleep apnea index fell from 64 ± 39 to 26 ± 26 (P < 0.0001). Although respiratory insufficiency of obesity patients had a higher operative mortality than did patients wtihout pulmonary dysfunction (2.4% vs 0.2% after gastric bypass), weight loss was associated with significant improvements in sleep apnea, arterial blood gases, pulmonary hypertension, left ventricular dysfunction, lung volumes, and polycythemia. Am J Clin Nutr 1992;55:597S-601S.