Manual Therapy, Posturology & Rehabilitation Journal
Manual Therapy, Posturology & Rehabilitation Journal
Research Article

Prevalence of sleep disorders in obese before bariatric surgery.

Carlos, Renata; Oliver, Nicole; Cruz, Ana Luísa F.; Silva, Suzanny Lays da; Souza, Jesimiel Missias de; Silva, Bruno Henrique F. da; Fialho, Davi; Bruno, Selma Sousa


Introduction: The prevalence of sleep disorders (SD) has increased significantly in recent decades in parallel to the worldwide obesity epidemic. The presence of SD provides an increased risk of postoperative complications, requiring greater care in these patients. The gold standard for evaluation and diagnosis of SD is polysomnography, but it is an expensive and highly complex exam, making the questionnaires and scales more accessible for diagnosis and screening. Objectives: To evaluate the presence of SD and to analyze the influence of anthropometric measures on the scores of the Epworth Sleepiness Scale (ESS), snoring (ERS) and Stanford Sleepiness Scale (SSS) in obese patients. Method: An observational, cross-sectional study performed from August 2015 to August 2016. The patients in the preoperative group of bariatric surgery of the University Hospital were submitted to anthropometric evaluation and application of the ESS, ERS and SSS during the preoperative physiotherapy evaluation. Results: Were evaluated 100 obese (78 women), mean age of 41.4±10.7 years and BMI of 46.1±7.8kg/m2 . SD were identified in 25% by ESS and 21% by SSS of obese. There were no differences between genders for the scales scores. The score of the ERS correlated itself with waist (r=0.20, p=0.04) and neck (r=0.33, p=0.001) circumferences. Conclusion: The use of scales for diagnosis of SD is useful in the follow-up of the preoperative of bariatric surgery and our study found that 25% of patients present daytime somnolence. We also observed the influence of waist and neck circumferences on increasing snoring scale.


Obesity, Snores, Obstructive Sleep Apnea Syndrome


1. St-Onge MP, Grandner MA, Brown D, Conroy MB, Jean-Louis G, Coons M, et al. Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: scientific statement from the American Heart Association. Circulation. 2016:134(18).

2. Colten HR, Altevogt BM. Institute of Medicine Committee on Sleep Medicine and Research. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington: National Academies Press; 2006.

3. Santos-Silva R, Tufik S, Conway SG, Taddei JA, Bittencourt LRA. Sao Paulo epidemiologic sleep study: rationale, design, sampling, and procedures. Sleep Med Rev. 2009:10(6):679–685.

4. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002:6:97–111.

5. Ferrie JE, Kumari M, Salo AP, Singh-Manoux A, Kivimaki M. Sleep epidemiology: a rapidly growing field. Int. J. Epidemiol. 2011;40(6):1431–7.

6. Faraut B, Touchette E, Gamble H, Royant-Parola S, Safar ME, Varsat B, et al. Short sleep duration and increased risk of hypertension: a primary care medicine investigation. J Hypertens. 2012:30:1354–63.

7. Canivet C, Nilsson PM, Lindeberg SI, Karasek R, Östergren PO. Insomnia increases risk for cardiovascular events in women and in men with low socioeconomic status: a longitudinal, register-based study. J Psychosom Res. 2014:76:292–99.

8. Gangwisch JE,Heymsfield SB,Boden-Albala B, Buijs RM, Kreier F, Pickering TG, et al. Sleep duration as a risk factor for diabetes incidence in a large U.S. sample. Sleep. 2007:30:1667–73

9. Gami AS, Caples SM, Somers VK. Obesity and obstructive sleep apnea. Endocrinol Metab Clin North Am. 2003:32:869-94.

10. Hora F, Nápolis LM, Daltro C, Kodaira SK, Tufik S, Togeiro SM, et al. Clinical, anthropometric and upper airway anatomic characteristics of obese patients with obstructive sleep apnea syndrome. Respiration. 2007:74:517-24.

11. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010:137(3):711-9.

12. Ruiz AJ, Martín A, Sepúlveda R, Franco OH, Cepeda M, Martinez PH, et al. The associations between sleep disorders and anthropometric measures in adults from three Colombian cities at different altitudes. Maturitas. 2016:94:1-10.

13. Mitchel LJ, Davidson ZE, Bonham M, O’Driscoll DM, Hamilton GS, Truby H. Weight loss from lifestyle interventions and severity of sleep apnoea: a systematic review and meta-analysis. Sleep Medicine. 2014:15:1173-83.

14. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2005:293(14):1726-37.

15. Silva ML, Melo RJP, Dabbicco P, Freitas CMSMF. Sleep during, overweight and obesity in adolescence: a systematic review. Man. Ther., Posturology Rehabil J. 2014:12:231-236,

16. Benumof JL. Obstructive sleep apnea in the adult obese patient: implications for airway management. J Clin Anesth. 2001:13:144-56.

17. Evans DJ, Hoffmann RG, Kalkhoff RK, Kissebah AH, Relationship of body fat topography to insulin sensitivity and metabolic profiles in premenopausal women: Metabolism. 1984:33(1):68-75.

18. Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, Xiang AH, Watanabe RN. A better index of body adiposity: Obesity. Silver.Spring. 2011:19(5):1083-1089.

19. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol. 2009:35(9):877-83.

20. Thuler ER, Dilbert RS, Fomin DS, et al. Uvulopalatoplastia a laser – Análise comparativa da melhora clínica e dos critérios de indicação. Rev Bras Otorrinolaringol. 2002;68(2):190-3.

21. Shahid A, Wilkinson K, Marcu S, et al. Stop, That and one hundred other sleep scales. Springer: New York; 2012.

22. Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003:13:676-83.

23. Gregório PB, Athanazio RA, Bitencourt AGV, Neves FBCS, Daltro C, Alves E, et al. Apresentação Clínica de Pacientes Obesos com Diagnóstico Polissonográfico de Apnéia Obstrutiva do Sono. Arq Bras Endocrinol Metab. 2007:51-7

24. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med. 1996:153(2):866-78.

25. Davidson TM, Patel MR. Waist circumference and sleep disordered breathing, Laryngoscope 2008:118(2):339–347.

26. Simpson L, Mukherjee S, Cooper MN, Ward KL, Lee JD, Fedson AC, et al. Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea. Sleep. 2010:33(4)467–474.

27. Shimura R, Tatsumi K, Nakamura A, Kasahara Y, Tanabe N, Takiguchi Y, et al. Fat accumulation, leptin, and hypercapnia in obstructive sleep apnea-hypopnea syndrome. Chest. 2005:127(2):543-9.

28. Imber DA, Pirrone M, Zhang C, Fisher DF, Kacmarek RM, Berra L. Respiratory Management of perioperative Obese Patients: A Literature Review. Respir Care. 2016. pii: respcare.04732

29. Cartagena R. Preoperative evaluation of patients with obesity and obstructive sleep apnea. Anesthesiol Clin North Am. 2005:23:463-78.

30. Laaban JP, Mounier L, Roque d’Orbcastel O, Melloni B, Cornette A, Muir JF. Assessment of recent weight history before instituting continuous positive airways pressure in a cohort of patients with severe obstructive sleep apnoea/hypopnea syndrome. Rev Mal Respir. 2014:31(1):41-7
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