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Kolotkin R.L.,Obesity and Quality of Life Consulting | Kolotkin R.L.,Duke University | Lamonte M.J.,State University of New York at Buffalo | Walker J.M.,Intermountain Sleep Disorders Center | And 4 more authors.
Surgery for Obesity and Related Diseases | Year: 2011

Background: Because of the high prevalence and potentially serious complications of obstructive sleep apnea (OSA) in obese individuals, several prediction models have been developed to detect moderate-to-severe OSA in patients undergoing bariatric surgery. Using commonly collected variables (body mass index [BMI], age, observed sleep apnea, hemoglobin A1c, fasting plasma insulin, gender, and neck circumference), Dixon et al. developed a model with a sensitivity of 89% and specificity of 81% for patients undergoing laparoscopic adjustable gastric band surgery suspected to have OSA. The present study evaluated the prediction model of Dixon et al. in 310 gastric bypass patients (mean BMI 46.8 kg/m 2, age 41.6 years, 84.5% women), with no preselection for OSA symptoms in a bariatric surgery partnership. Methods: The patients underwent overnight limited polysomnography to determine the presence and severity of OSA as measured using the apnea-hypopnea index. Results: Of the 310 patients, 44.2% had moderate-to-severe OSA (apnea-hypopnea index <15/h). Most variables in the Dixon model were associated with a greater prevalence of OSA. The sensitivity (75%) and specificity (57%) for the model-based classification of OSA were considerably lower in the present sample than originally reported. An alternate prediction model identified 10 unique predictors of OSA. The presence of <5 of these predictors modestly improved the sensitivity (77%) and greatly improved the specificity (77%) in predicting an apnea-hypopnea index of <15/h. When applied to the validation sample, the sensitivity (76%) and specificity (72%) were essentially the same. Conclusion: Although the Dixon model and our model included overlapping predictors (BMI, gender, age, neck circumference), when applied in our sample of gastric bypass patients, neither model achieved the sensitivity and specificity for predicting OSA previously reported by Dixon et al. © 2011 American Society for Metabolic and Bariatric Surgery. Source

Hammoud A.O.,University of Utah | Walker J.M.,Intermountain Sleep Disorders Center | Gibson M.,University of Utah | Cloward T.V.,Intermountain Sleep Disorders Center | And 6 more authors.
Obesity | Year: 2011

The effect of sleep apnea on the reproductive function of obese men is not entirely elucidated. The objective of this study was to define the effect of sleep apnea on the reproductive hormones and sexual function in obese men. This study included 89 severely obese men with BMI 35kg/m 2 considering gastric bypass surgery. Anthropometrics (weight, and BMI), reproductive hormones, and sleep studies were measured. The sexual quality of life was assessed using the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-Lite). The mean age of our patients was 46.9 11.0 years, the mean BMI was 47.8 8.7kg/m 2 and the mean weight was 337.7 62.4lb. After correction for age and BMI, means of free testosterone per severity group of sleep apnea were as follows: no or mild sleep apnea 74.4 3.8pg/ml, moderate sleep apnea 68.6 4.2pg/ml, and severe sleep apnea 60.2 2.92pg/ml, P = 0.014. All other parameters of sleep apnea including hypopnea index, percent time below a SpO 2 of 90%, and percent time below a SpO 2 of 80% were also negatively correlated with testosterone levels after correction for age and BMI. BMI and presence of coronary artery disease decreased the sexual quality of life. Sleep apnea was associated with reduced sexual quality of life. In summary, sleep apnea negatively affects testosterone levels independent of BMI. Severely obese men had decreased sexual quality of life. © 2011 The Obesity Society. Source

Adams T.D.,University of Utah | Adams T.D.,Intermountain Health and Fitness Institute | Davidson L.E.,University of Utah | Litwin S.E.,University of Utah | And 20 more authors.
JAMA - Journal of the American Medical Association | Year: 2012

Context: Extreme obesity is associated with health and cardiovascular disease risks. Although gastric bypass surgery induces rapid weight loss and ameliorates many of these risks in the short term, long-term outcomes are uncertain. Objective: To examine the association of Roux-en-Y gastric bypass (RYGB) surgery with weight loss, diabetes mellitus, and other health risks 6 years after surgery. Design, Setting, and Participants: A prospective Utah-based study conducted between July 2000 and June 2011 of 1156 severely obese (body mass index [BMI] ≥35) participants aged 18 to 72 years (82% women; mean BMI, 45.9; 95% CI, 31.2-60.6) who sought and received RYGB surgery (n=418), sought but did not have surgery (n=417; control group 1), or who were randomly selected from a population-based sample not seeking weight loss surgery (n=321; control group 2). Main Outcome Measures: Weight loss, diabetes, hypertension, dyslipidemia, and health-related quality of life were compared between participants having RYGB surgery and control participants using propensity score adjustment. Results: Six years after surgery, patients who received RYGB surgery (with 92.6% follow-up) lost 27.7% (95% CI, 26.6%-28.9%) of their initial body weight compared with 0.2% (95% CI, -1.1% to 1.4%) gain in control group 1 and 0% (95% CI, -1.2% to 1.2%) in control group 2. Weight loss maintenance was superior in patients who received RYGB surgery, with 94% (95% CI, 92%-96%) and 76% (95% CI, 72%-81%) of patients receiving RYGB surgery maintaining at least 20% weight loss 2 and 6 years after surgery, respectively. Diabetes remission rates 6 years after surgery were 62% (95% CI, 49%-75%) in the RYGB surgery group, 8% (95% CI, 0%-16%) in control group 1, and 6% (95% CI, 0%-13%) in control group 2, with remission odds ratios (ORs) of 16.5 (95% CI, 4.7-57.6; P<.001) vs control group 1 and 21.5 (95% CI, 5.4-85.6; P<.001) vs control group 2. The incidence of diabetes throughout the course of the study was reduced after RYGB surgery (2%; 95% CI, 0%-4%; vs 17%; 95% CI, 10%-24%; OR, 0.11; 95% CI, 0.04-0.34 compared with control group 1 and 15%; 95% CI, 9%-21%; OR, 0.21; 95% CI, 0.06-0.67 compared with control group 2; both P<.001). The numbers of participants with bariatric surgery-related hospitalizations were 33 (7.9%), 13 (3.9%), and 6 (2.0%) for the RYGB surgery group and 2 control groups, respectively. Conclusion Among severely obese patients, compared with nonsurgical control patients, the use of RYGB surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over 6 years. ©2012 American Medical Association. All rights reserved. Source

Adams T.D.,University of Utah | Adams T.D.,Intermountain Health and Fitness Institute | Pendleton R.C.,University of Utah | Strong M.B.,University of Utah | And 26 more authors.
Obesity | Year: 2010

Favorable health outcomes at 2 years postbariatric surgery have been reported. With exception of the Swedish Obesity Subjects (SOS) study, these studies have been surgical case series, comparison of surgery types, or surgery patients compared to subjects enrolled in planned nonsurgical intervention. This study measured gastric bypass effectiveness when compared to two separate severely obese groups not participating in designed weight-loss intervention. Three groups of severely obese subjects (N = 1,156, BMI 35 kg/m 2) were studied: gastric bypass subjects (n = 420), subjects seeking gastric bypass but did not have surgery (n = 415), and population-based subjects not seeking surgery (n = 321). Participants were studied at baseline and 2 years. Quantitative outcome measures as well as prevalence, incidence, and resolution rates of categorical health outcome variables were determined. All quantitative variables (BMI, blood pressure, lipids, diabetes-related variables, resting metabolic rate (RMR), sleep apnea, and health-related quality of life) improved significantly in the gastric bypass group compared with each comparative group (all P 0.0001, except for diastolic blood pressure and the short form (SF-36) health survey mental component score at P 0.01). Diabetes, dyslipidemia, and hypertension resolved much more frequently in the gastric bypass group than in the comparative groups (all P 0.001). In the surgical group, beneficial changes of almost all quantitative variables correlated significantly with the decrease in BMI. We conclude that Roux-en-Y gastric bypass surgery when compared to severely obese groups not enrolled in planned weight-loss intervention was highly effective for weight loss, improved health-related quality of life, and resolution of major obesity-associated complications measured at 2 years. Source

Owan T.,University of Utah | Avelar E.,University of Connecticut | Morley K.,University of Utah | Jiji R.,University of Utah | And 17 more authors.
Journal of the American College of Cardiology | Year: 2011

Objectives: The objective of this study was to test the hypothesis that gastric bypass surgery (GBS) would favorably impact cardiac remodeling and function. Background: GBS is increasingly used to treat severe obesity, but there are limited outcome data. Methods: We prospectively studied 423 severely obese patients undergoing GBS and a reference group of severely obese subjects that did not have surgery (n = 733). Results: At a 2-year follow up, GBS subjects had a large reduction in body mass index compared with the reference group (-15.4 ± 7.2 kg/m2 vs. -0.03 ± 4.0 kg/m 2; p < 0.0001), as well as significant reductions in waist circumference, systolic blood pressure, heart rate, triglycerides, low-density lipoprotein cholesterol, and insulin resistance. High-density lipoprotein cholesterol increased. The GBS group had reductions in left ventricular (LV) mass index and right ventricular (RV) cavity area. Left atrial volume did not change in GBS but increased in reference subjects. In conjunction with reduced chamber sizes, GBS subjects also had increased LV midwall fractional shortening and RV fractional area change. In multivariable analysis, age, change in body mass index, severity of nocturnal hypoxemia, E/E′, and sex were independently associated with LV mass index, whereas surgical status, change in waist circumference, and change in insulin resistance were not. Conclusions: Marked weight loss in patients undergoing GBS was associated with reverse cardiac remodeling and improved LV and RV function. These data support the use of bariatric surgery to prevent cardiovascular complications in severe obesity. © 2011 American College of Cardiology Foundation. Source

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