Explore this issue:July 2012
Bariatric surgery may seem like an extreme treatment for OSA, but there’s evidence to suggest that it may be helpful. Research studies that measured the presence and severity of OSA in obese teenagers both before and after weight-loss surgery suggest that weight-loss surgery typically resolves or greatly reduces the severity of OSA (Obesity. 2009;17(5):901-910, Obes Surg. 2003;13(1):58-61).
Evan Nadler, MD, director of the bariatric surgery program and co-director of the Obesity Institute at Children’s National Medical Center in Washington, D.C., said bariatric surgery should be considered as a possible treatment for OSA (and obesity) for morbidly obese teens. “Any adolescent who meets the adult standards for weight-loss surgery should at least be evaluated by an adolescent weight-loss surgeon, even if it’s just an information-gathering exercise,” he said. Teens who have a BMI of 35 with a significant comorbidity like sleep apnea qualify, as do teens with a BMI of 40 without a comorbidity.
“I actually had one patient who avoided an adenotonsillectomy by having weight-loss surgery,” said Dr. Nadler. “The patient had generous tonsils, but neither I nor the [otolaryngologist] felt that the tonsils were the main contributor toward the sleep apnea. So after discussing the case, he and I decided to proceed with weight-loss surgery first.” The morbidly obese teenager underwent bariatric surgery and so far has not needed any additional treatment for OSA.
Bariatric surgery requires significant commitment from the patient, so almost all obesity centers require prospective candidates to be actively involved in a weight management program before undergoing surgery. “A patient cannot be successful without a huge amount of behavior change. If they’re not in the right place mentally and showing success beforehand, then it’s likely that the surgery will not be successful in the long term,” said Dr. Pont.
Insurance companies are increasingly willing to pay for bariatric surgery. “If I have a 15- or 16-year-old with severe OSA and morbid obesity, it’s fairly easy for me to convince an insurance company why it’s in the child’s best interest to have surgery,” Dr. Nadler said.