Bariatric Surgery-Induced Resolution
of Hypertension and Obstructive Sleep Apnea: Impact
of Modulation of Body Fat, Ectopic Fat, Autonomic Nervous
Activity, Inflammatory and Adipokine Profiles
Sebastian Demian Parlee
David H. St-Pierre
Published online: 29 May 2017
Springer Science+Business Media New York 2017
Background Obesity-associated systemic hypertension (HTN)
and obstructive sleep apnea (OSA) have multiple pathophysio-
logical pathways including ectopic fat deposition, inflammation,
altered adipokine profile, and increased sympathetic nervous ac-
tivity. We characterized these potential mechanisms in severely
obese patients with or without HTN and OSA. We also com-
pared changes of these mechanisms at 12 months following
biliopancreatic diversion with duodenal switch (BPD-DS) sur-
gery according to HTN and OSA resolution.
Methods Sixty-two severely obese patients were evaluated at
baseline and 12 months; 40 patients underwent BPD-DS.
Blood samples, bioelectrical impedance analysis, computed
tomography scan, and 24-h heart rate monitoring were per-
formed. OSA have been determined with polysomnography
and HTN with blood pressure measurement and medical file.
Results Patients with HTN (n =35)andOSA(n = 32) were older
men with higher ectopic fat deposition and lower parasympathet-
ic nervous activity without difference in adipokines and inflam-
matory markers. Lower reduction in weight was observed in
patients with unresolved HTN (−40.9±3.3kgvs.
−55.6 ± 3.8 kg; p =0.001)andOSA(−41.4 ± 10.7 kg vs.
−51.0 ± 15.2 kg; p = 0.006). Visceral adipose tissue reduction
was lower in patients with unresolved HTN (−171.0 ± 25.7 cm
vs. −274.5 ± 29.0 cm
; p = 0.001) in contrast to a trend for lower
abdominal subcutaneous adipose tissue reduction in patients with
unresolved OSA (−247.7 ± 91.5 cm
vs. −390.5 ± 109.1 cm
p = 0.08). At 12 months, parasympathetic activity was lowest in
unresolved HTN and OSA patients, without difference in
adipokines and inflammatory biomarkers.
Conclusion Lower ectopic fat mobilization, lower level of
parasympathetic nervous activity, and lower subcutaneous ad-
iposity mobilization may play a role in the pathophysiology of
unresolved HTN and OSA following BPD-DS surgery.
Keywords Severe obesity
Obstructive sleep apnea
Body fat distribution
Severe obesity is associated with comorbidities such as sys-
temic hypertension (HTN) and obstructive sleep apnea (OSA)
. Prevalence of HTN and OSA is higher in severely obese
patients in comparison to normal-weight patients [2, 3].
Electronic supplementary material The online version of this article
(doi:10.1007/s11695-017-2737-z) contains supplementary material,
which is available to authorized users.
* Paul Poirier
Institut Universitaire de Cardiologie et de Pneumologie de Québec,
Faculty of Pharmacy, Laval University, Québec, Canada
Faculty of Medicine, Laval University, Québec, Canada
Department of Molecular & Integrative Physiology, University of
Michigan School of Medicine, Detroit, USA
College of Pharmacy, Dalhousie University, Halifax, Canada
Department of Pharmacology, Dalhousie University, Halifax, Canada
Department of Exercise Sciences, Université du Québec à Montréal,
OBES SURG (2017) 27:3156–3164