The effect of laparoscopic sleeve gastrectomy on OSAHS in obesity patients: a Meta-Analysis

doi:10.3877/cma.j.issn.2095-9605.2022.03.007

Abstract

Abstract:

Objective

To evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) in obese patients obstructive sleep apnea and hypopnea syndrome (OSAHS). To provide an evidence-based basis for LSG treatment of obesity OSAHS.

Methods

Computer search databases from January 1980 to June 2022: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Database, VIP Database, Chinese BioMedical Literature Database. We searched for high-quality clinical studies on obesity OSAHS patients, LSG as an intervention, and postoperative polysomnography monitoring as an outcome indicator, strictly according to the inclusion and exclusion criteria. Data extraction and assessment of publication bias were performed for the included literature. The postoperative apnea-hypopnea index (AHI), minimum SpO₂ during sleep, sleep efficiency, and Epworth Sleepiness Scale (ESS) was used to objectively evaluate the severity of sleep apnea and hypoventilation. Body Mass Index (BMI) and neck circumference were used as indicators to objectively evaluate weight loss. They were compared with their preoperative baseline data. Forest plots showed a large heterogeneity among studies, which was mainly attributed to the small number of included literature and the fact that they were all owned before and after controlled studies.

Results

A total of 7 studies were included in 316 patients with obesity OSAHS and with a high risk of migration. The results of this meta-analysis showed that LSG has significant and statistically significant improvements in all of the following indicators, BMI (MD=13.36, 95%CI: [11.55, 15.18], P<0.05), apnea hypoventilation index (AHI)(MD=24.54, 95%CI: [15.44, 33.73], P<0.05) , minimum oxygen saturation (MinSaO₂) (MD=–13.95, 95%CI: [–22.61, –5.29], P<0.05) , rapid eye movement (REM) sleep as a percentage of total sleep time (MD=–2.70, 95% CI: [–4.37, –1.02], P<0.05), Epworth Sleepiness Scale score (ESS) (MD=5.17, 95%CI: [1.99, 8.35], P<0.05) and neck circumference (MD=5.65, 95%CI: [4.52, 6.78], P<0.05).There was no significant effect on sleep efficiency (MD=–6.30, 95%CI:[–12.88, 0.28], P=0.06).

Conclusions

LSG has significant therapeutic effects on obesity and OSAHS in obese OSAHS patients, but further observation is needed for the long-term efficacy of this operation.

Key words: Laparoscopic sleeve gastrectomy, Bariatric surgery, Obesity, Obstructive sleep apnea-hypopnea syndrome, Meta-analysis

Jiaming Zhang, Xiaofang Sun. The effect of laparoscopic sleeve gastrectomy on OSAHS in obesity patients: a Meta-Analysis[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(03): 181-190.

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Figures/Tables 15

References 40

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作者及发表年份	国家	研究类型	样本量	随访时间（月）	BMI（kg/m²）		AHI（events/h）		REM/%		NadirSaO₂/%		ESS		SSE		颈围
作者及发表年份	国家	研究类型	样本量	随访时间（月）	术前	术后	术前	术后	术前	术后	术前	术后	术前	术后	术前	术后	术前	术后
艾克拜尔et al. 2020	中国	前瞻性	74	12	43±6	28±3	30±19	6±4	NS	NS	64.9±11.3	88±3.1	19.4±2.6	9.2±1.5	NS	NS	42.9±3	36.5±1.4
H.Shaarawy et al., 2015	埃及	回顾性	22	12	48.2±7.3	35.9±4.8	55.8±8.3	12.8±11.3	20.4±2.9	22.4±1.9	67.2±11.3	92.2±5.3	16.8±6.8	10.2±4.5	69.4±3.25	75.4±6.25	38.2±3.6	32.2±4.6
Suliman et al., 2015	埃及	回顾性	20	8.25±0.96	60.5±8.9	41.9±5.9	18（8.2-42）	10(3-22)	NS	NS	82.35±6.44	87.10±4.78	5.4±2.54	2.7±1.5	83.75±7.18	90.35±3.66	42.05±2.87	38.6±2.76
Salmanet al., 2019	埃及	前瞻性	79	12	46.23±3.8	34.2±2.7	27.3±12.2	14.0±9.8	NS	NS	NS	NS	9.2±3.6	5.0±3.0	NS	NS	45.1±2.6	38.24±2.7
Timmerman et al., 2019	法国	前瞻性	36	9.9±6.1	47.4±8.4	36.3±7.1	45.8±25.6	11.3±11.9	14.2±6.4	16.3±7.4	NS	NS	7.2±5.0	3.3±3.4	NS	NS	43.9±3.9	40.2±3.7
Kara et al., 2020	土耳其	前瞻性	31	12	49.8±8.5	33.2±8.2	36.1±27	10.3±11.8	14.0±6.3	18.9±5.8	74.3±12.1	79.2±14.7	5.1±3.7	1.6±1.6	NS	NS	44.4±4.2	37.4±4.0
Yufei Chen et al., 2021	中国	回顾性	67	9.7±2.8	42.6±7.7	31.9 ± 5.9	31.9 ± 28.6	13.3 ± 15.8	NS	NS	79.0 (63.0–83.0)	87.0 (82.0–90.0)	NS	NS	NS	NS	NS	NS

作者及发表年份	国家	研究类型	样本量	随访时间（月）	BMI（kg/m²）		AHI（events/h）		REM/%		NadirSaO₂/%		ESS		SSE		颈围
作者及发表年份	国家	研究类型	样本量	随访时间（月）	术前	术后	术前	术后	术前	术后	术前	术后	术前	术后	术前	术后	术前	术后
艾克拜尔et al. 2020	中国	前瞻性	74	12	43±6	28±3	30±19	6±4	NS	NS	64.9±11.3	88±3.1	19.4±2.6	9.2±1.5	NS	NS	42.9±3	36.5±1.4
H.Shaarawy et al., 2015	埃及	回顾性	22	12	48.2±7.3	35.9±4.8	55.8±8.3	12.8±11.3	20.4±2.9	22.4±1.9	67.2±11.3	92.2±5.3	16.8±6.8	10.2±4.5	69.4±3.25	75.4±6.25	38.2±3.6	32.2±4.6
Suliman et al., 2015	埃及	回顾性	20	8.25±0.96	60.5±8.9	41.9±5.9	18（8.2-42）	10(3-22)	NS	NS	82.35±6.44	87.10±4.78	5.4±2.54	2.7±1.5	83.75±7.18	90.35±3.66	42.05±2.87	38.6±2.76
Salmanet al., 2019	埃及	前瞻性	79	12	46.23±3.8	34.2±2.7	27.3±12.2	14.0±9.8	NS	NS	NS	NS	9.2±3.6	5.0±3.0	NS	NS	45.1±2.6	38.24±2.7
Timmerman et al., 2019	法国	前瞻性	36	9.9±6.1	47.4±8.4	36.3±7.1	45.8±25.6	11.3±11.9	14.2±6.4	16.3±7.4	NS	NS	7.2±5.0	3.3±3.4	NS	NS	43.9±3.9	40.2±3.7
Kara et al., 2020	土耳其	前瞻性	31	12	49.8±8.5	33.2±8.2	36.1±27	10.3±11.8	14.0±6.3	18.9±5.8	74.3±12.1	79.2±14.7	5.1±3.7	1.6±1.6	NS	NS	44.4±4.2	37.4±4.0
Yufei Chen et al., 2021	中国	回顾性	67	9.7±2.8	42.6±7.7	31.9 ± 5.9	31.9 ± 28.6	13.3 ± 15.8	NS	NS	79.0 (63.0–83.0)	87.0 (82.0–90.0)	NS	NS	NS	NS	NS	NS

条目	研究
条目	艾克拜尔et al., 2020	H.Shaarawy et al., 2015	Suliman et al., 2015	Salman et al., 2019	Timmerman et al., 2019	Kara et al., 2020	Yufei Chen et al., 2021
1.是否清晰地说明了研究的假设、目的和目标？	1	1	1	1	1	1	1
2.是否描述了患者特点？	1	1	1	1	1	1	1
3.是否在多中心收集病例？	0	0	0	1	0	0	0
4.研究纳入标准和排除标准是否明确合理？	1	1	1	1	1	1	1
5.患者的纳入是否连续？	0	0	0	0	1	0	0
6.患者的病情是否一致？	1	1	1	1	1	1	1
7.是否清楚地描述了主要的干预措施？	1	1	0	0	0	0	1
8.是否明确描述了联合干预措施？	1	0	0	0	0	0	1
9.是否事先确定研究要测量的结局？	1	1	1	1	1	1	1
10.是否应用合理的客观和（或）主观方法测量了相关结局指标？	1	1	1	1	1	1	1
11.干预前后是否均测量了结局指标？	1	1	1	1	1	1	1
12.是否应用了合理的统计学检验来评价相关结局指标？	1	1	1	1	1	1	1
13.是否报告了随访时间？	1	1	1	1	1	1	1
14.是否报告了失访情况？	1	1	1	1	1	1	1
15.是否在相关的结局指标的数据分析中提供了随机变量估计？	1	1	1	1	1	1	1
16.是否报告了干预相关的不良事件？	1	1	0	1	0	1	1
17.研究的结果是否支持其结论？	1	1	1	1	1	1	1
18.是否说明了研究的利益冲突和支持来源？	1	1	1	1	1	1	1
19.该研究是否为前瞻性研究？	0	1	1	1	0	1	0
20.是否对结局评价人员施盲？	0	0	0	0	0	0	0
总分	16	16	14	16	14	15	16

条目	研究
条目	艾克拜尔et al., 2020	H.Shaarawy et al., 2015	Suliman et al., 2015	Salman et al., 2019	Timmerman et al., 2019	Kara et al., 2020	Yufei Chen et al., 2021
1.是否清晰地说明了研究的假设、目的和目标？	1	1	1	1	1	1	1
2.是否描述了患者特点？	1	1	1	1	1	1	1
3.是否在多中心收集病例？	0	0	0	1	0	0	0
4.研究纳入标准和排除标准是否明确合理？	1	1	1	1	1	1	1
5.患者的纳入是否连续？	0	0	0	0	1	0	0
6.患者的病情是否一致？	1	1	1	1	1	1	1
7.是否清楚地描述了主要的干预措施？	1	1	0	0	0	0	1
8.是否明确描述了联合干预措施？	1	0	0	0	0	0	1
9.是否事先确定研究要测量的结局？	1	1	1	1	1	1	1
10.是否应用合理的客观和（或）主观方法测量了相关结局指标？	1	1	1	1	1	1	1
11.干预前后是否均测量了结局指标？	1	1	1	1	1	1	1
12.是否应用了合理的统计学检验来评价相关结局指标？	1	1	1	1	1	1	1
13.是否报告了随访时间？	1	1	1	1	1	1	1
14.是否报告了失访情况？	1	1	1	1	1	1	1
15.是否在相关的结局指标的数据分析中提供了随机变量估计？	1	1	1	1	1	1	1
16.是否报告了干预相关的不良事件？	1	1	0	1	0	1	1
17.研究的结果是否支持其结论？	1	1	1	1	1	1	1
18.是否说明了研究的利益冲突和支持来源？	1	1	1	1	1	1	1
19.该研究是否为前瞻性研究？	0	1	1	1	0	1	0
20.是否对结局评价人员施盲？	0	0	0	0	0	0	0
总分	16	16	14	16	14	15	16

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