Talks：	Impact of metabolic surgery on sleep disorders
Name：	黃致錕
Position：	SUPERINTENDENT
Affiliation：	China Medical University Hospital Body science & Metabolic disorders International Medical Center
Email：	dr.ckhuang@hotmail.com
Photo：
Research Interests：	Laparoscopic bariatric & metabolic surgery / Single incision trans-umbilical laparoscopic surgery
Selected Publications：	◆Chang PC, Dev A, Katakwar A, Hsin MC, Tai CM, Huang CK. Management of gastric fold herniation after laparoscopic adjustable gastric banded plication: a single-center experience. Surg Obes Relat Dis. 2016 May;12(4):849-55. ◆Tai CM, Huang CK, Tu HP, Hwang JC, Yeh ML, Huang CF, Huang JF, Dai CY, Chuang WL, Yu ML. Interactions of a PPARGC1A Variant and a PNPLA3 Variant Affect Nonalcoholic Steatohepatitis in Severely Obese Taiwanese Patients. Medicine (Baltimore). 2016 Mar;95(12):e3120. ◆Chang PC, Huang CK, Rajan M, Hsin MC. Revision with Totally Hand-Sewn Gastrojejunostomy and Vagotomy for Refractory Marginal Ulcer after Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg. 2016 May;26(5):1150. ◆Wang MY, Huang CK, Chang PC. Hypopharyngeal perforation with mediastinal dissection during orogastric tube placement: a rare complication of bariatric surgery. Surg Obes Relat Dis. 2016 Feb;12(2):e17-9. ◆Huang CK, Tai CM, Chang PC, Malapan K, Tsai CC, Yolsuriyanwong K. Loop Duodenojejunal Bypass with Sleeve Gastrectomy: Comparative Study with Roux-en-Y Gastric Bypass in Type 2 Diabetic Patients with a BMI <35 kg/m(2), First Year Results. Obes Surg. 2016 Mar 2. ◆Shen SC, Lin HY, Huang CK, Yen YC. Erratum to: Adherence to Psychiatric Follow-up Predicts 1-Year BMI Loss in Gastric Bypass Surgery Patients. Obes Surg. 2016 Apr;26(4):816. ◆Ahluwalia JS, Chang PC, Tai CM, Tsai CC, Sun PL, Huang CK. Comparative Study Between Laparoscopic Adjustable Gastric Banded Plication and Sleeve Gastrectomy in Moderate Obesity-2 Year Results. Obes Surg. 2016 Mar;26(3):552-7.
Abstract：	Obesity has adverse effects on respiratory physiology and function. Associated respiratory diseases with obesity are - Obstructive sleep apnea(OSA), Obesity hypoventilation syndrome (OHS), Asthma and Pulmonary hypertension. Compliance is reduced due to decrease in chest wall compliance & excess fat accumulation around ribs, diaphragm and abdomen. Total respiratory resistance and airway resistance are increased. Obese patients spend more of their oxygen consumption on respiratory work during quiet breathing. Limited energy reserve in these patients predispose to energy failure in acute pulmonary and systemic illness. The incidence of OSA in the morbidly obese population is increased, and has been reported between 38% and 88%. OSA has been linked to premature death, traffic accidents, hypertension, ischemic heart disease, stroke, type II diabetes, increased neck circumference, and visceral obesity. The combination of OSA with daytime symptoms is called OSAHS (Obstructive sleep apnea hypopnea syndrome). Systemic and pulmonary hypertension are seen if left untreated. CPAP is the treatment of choice for OSA. Its use pre operatively reduces the risk of preoperative complications. Up to 2-3 weeks of CPAP is required to reduce AHI. 50 - 70% of patients with OSA are obese. After Metabolic Surgery A ten percent increase in weight predicted a 6-fold increase in the odds of developing moderate-to-severe OSA. Weight loss by any method, including that following metabolic surgery, is a well-documented treatment for OSA. Metabolic surgery refers to treatment of obesity and related metabolic disorders by gastrointestinal surgery. No wit has been proved to be the most effective treatment , when compared with all other medical intervention. Not only in reduction of weight , but also other remission of co-morbidities are also observed, including OSA. Significant increase in lung volumes and arterial oxygen saturation with reduction in PaCO2 have been observed. Improvements in ventilation/ perfusion mismatching and reduction in work of breathing are also noted. In general, many patients after bariatric surgery will develop clinical improvement or resolution of symptoms of OSA, regardless of whether a normal BMI is ever achieved, as even a modest weight loss of 10-20% has been associated with improvement of symptoms and greater than 26% reduction in AHI (Apnea-Hyponea Index). Postop monitoring of metabolic surgical patients with OSA depends on type of procedure, approach (laparoscopic vs. open), Severity of sleep apnea, comorbidities and individual facility capabilities. Minimum requirements to monitor include pulse oximetry or capnography in the post-anesthesia care unit. Selected higher risk patients - Males, BMI >60, Severe OSA, and Age >50 may be monitored in an ICU setting at the discretion of surgeon. Conclude Metabolic surgery has been approved to improve symptoms of OSA with a reduction in AHI, cure is not uncommon.