Bariatric Services We have a specialized unit within our patient care division staffed by very experienced licensed respiratory care professionals focused on serving bariatric (weight loss surgery) patients who also suffer from Obstructive Sleep Apnea (OSA). In fact nearly half our patients are those who are intending to undergo or have undergone some kind of weight loss surgery.

In addition to our professional OSA treatment services, we have developed a specialization in patient care for bariatric (weight loss surgery) patients who suffer from Obstructive Sleep Apnea. In fact nearly half our patients are people who are preparing to undergo or have undergone some kind of weight loss surgery. Our specialized staff of highly experienced licensed respiratory care professionals has been trained to provide the best possible care and support. Studies show that approximately 70% of OSA treated patients are obese and that 75% of the people who qualify for bariatric surgery will suffer from OSA. Since OSA dramatically reduces the quality of life and is associated with significant increased mortality in morbidly obese people, these facts reflect a very serious condition.

If you are a bariatric patient, undiagnosed or untreated OSA can impact you pre-operatively and post-operatively. This is because obesity itself predisposes to hypoxemia (a deficiency in the amount of oxygen reaching the body tissues) following surgery. Anesthesia and narcotic analgesics exacerbate pre-existing OSA to further contribute to the hyperemic burden (see Practice Guidelines for the Periopertive Management of Patients with Obstructive Sleep Apnea - American Society of Anesthesiologists). In addition, studies have shown an increased persistence and serious post-operative complications following surgery (not just bariatric surgery), which are seen in patients with undiagnosed or untreated OSA, compared to those with treated OSA or without OSA (Massie & Hart 2010). OSA may also be associated with changes in leptin and ghrelin levels, increasing appetite and calorie intake, exacerbating obesity. Thus it appears that obesity and OSA for a vicious cycle each resting in the worsening of the other (Pillar et al 2008).

OSA Treatment for Bariatric Patients - Don't Compromise Your Health!
If you are a potential bariatric patient and have been diagnosed with OSA, or if you were told by your doctor that you need treatment for your OSA prior to surgery, you should start your treatment as soon as possible! Too many patients relate to the OSA treatment as just another part of the preparations before the bariatric surgery. This is wrong of course! OSA treatment is not only a necessary step for a successful surgery, but also an essential component of the post-surgery weight-loss process.

The lack of quality sleep, continuous fatigue, headaches and general weakness caused by untreated OSA will quickly consume most of your energy. Moreover, it will affect your efforts to keep up with the post-surgery dieting plan and exercise regime. A rehabilitation failure can plunge you back into the same viscous cycle you were suffering from before the surgery. Unfortunately, there are no short cuts. The ongoing high level, personalized patient care needed to help you stay compliant with the treatment will deliver huge dividends, increasing the long term success of your bariatric surgery.

It is a known fact that very few patients can heal from their OSA through weight loss alone. Although the weight decrease after the bariatric surgery may lower the immediate urgency of the OSA treatment, the treatment must not be stopped! Being aware of the importance of the continued compliance with the therapy, our Bariatric Unit will work with you closely to increase awareness and guarantee the success of your OSA treatment.

We will collaborate with physicians and sleep labs we work with to deliver the CPAP equipment that best fits the requirements of your treatment. This is usually the auto-titrating devices that automatically adjust the pressure required to maintain therapy as you go through rapid weight loss. These devices lower the incidence of many potential treatment side-effects, such as stomach gas and bloating that occurs when pressures are too high. Feel free to call us and we'll be happy to answer your questions.

What is Leptin & How Does CPAP Therapy Help Regulate Leptin Output? Treating your OSA with CPAP therapy will help you reduce weight by better regulating your leptin levels (Patel et al 2004, Harsch et al 2003). Leptin is a hormone made in your white adipose tissue (stored fat). It works to tell your brain if you are hungry or when you have eaten enough. This means that your stored fat is actually a metabolic organ, not just a repository for extra calories. When your leptin level is low it signals to the body you need to eat and when it is high it sends out a signal to your brain that you are full. One of the most basic leptin problems encountered if you are overweight is that your body becomes desensitized to the leptin signal, in the same way you become insulin resistant when you develop diabetes. This means that you will have a subconscious drive to eat more food than you really need, in order to feel satisfied. And there is a double impact as at the same time your body can think you are hungry and thus adjusts your metabolic rate downward, setting it into hibernation mode so that you don't perish from malnutrition, not knowing that you are actually eating more than you need.

What is Ghrelin & How Does CPAP Therapy Help Regulate Ghrelin Output? Ghrelin is a hormone that stimulates hunger produced by cells lining the fundus of the human stomach and epsilon cells of the pancreas. Ghrelin levels increase before meals and decrease after meals. It is considered the counterpart of the hormone leptin. In some bariatric procedures, the level of ghrelin is reduced in patients, thus causing satiation before it would normally occur. It is also thought that treatment of OSA may reduce ghrelin levels leading to decreased appetite (Harsch et al 2003) and a lower BMI thus playing an important role in the management of obesity (Takahashi et al 2008).