Wednesday, 12 July 2017

Gastric bypass surgery associated with increased sleep-medication use

A new study led by SPHPM PhD student Winda Ng has shown that gastric bypass surgery is associated with increased use of medication to enable sleep. The findings, published in Obesity, were consistent at both 3- and 5-years post-surgery and reveal a need for ongoing support to these patients.

Winda and her research colleagues at Karolinska Institutet, Deakin University and The Baker Institute compared two groups of Swedish adults 18 years and over with obesity. One group lost weight by gastric bypass surgery, whilst the other underwent intensive lifestyle change programs. At one-year follow-up, the surgical group lost 37kg on average, and the lifestyle modification group lost 18kg on average.

The two cohorts were matched on BMI, age, sex, education, treatment year and history of hypnotics and/or sedatives (sleep medications) use by filled prescriptions. Every year for three years after treatment, the researchers monitored filled prescriptions for sleep medications.

In the year prior to treatment, the average rate of filled prescriptions for sleep medication was 4%. At one-year post treatment, 7% of the surgical cohort filled scripts whilst the lifestyle group remained constant at 4%. At two years, that expanded out to 11% versus 5%, and at three years it had blown out as far as 14% versus 6%. This trend continued up to 5 years follow-up.
PhD student Winda Ng

Winda says,

“That use of sleep medications increased after gastric bypass surgery is concerning as they have been associated with increased risk of accidents, injuries, and cognitive decline. More research needs to be done to understand why use increases, so we can prevent it. In the meantime, it’s important that doctors managing people post-bariatric surgery watch for this.”

The authors speculated about a number of potential causes. One possibility is “addiction transfer,” whereby patients stop overeating for anxiety relief but acquire other compulsive disorders such as alcoholism or substance abuse after bariatric surgery. This phenomenon is debated but is continually being reported in bariatric surgery patients. The observed increase in use of sleep medications after gastric bypass surgery may have occurred through similar pathway.

Another plausible explanation suggested by literature is that gastric bypass increases the risk of alcoholism and substance abuse. This in turn leads to poor sleep, and potentially the increased use of sleep medications. 

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