Bariatric Surgery Cured OSA In a Little More Than Half of Patients After 5 Years

For some people, bariatric surgery may cure obstructive sleep apnea (OSA). A recent study found the surgery fully treated OSA in 55% of patients after 5 years.¹

“Three of five patients were considered to have been cured (i.e., they had an [apnea-hypopnea index] < 5),” wrote investigators, led by Pipsa Peromaa-Haavisto, MD, PhD, from the department of surgery at Tampere University Hospital Hatanpää.

Since obesity is a common risk factor for OSA, many bariatric surgery candidates have this sleep-breathing disorder. Although individuals with OSA may suffer from symptoms like daytime sleepiness and poor concentration, some individuals with OSA may be asymptomatic—and might not be aware they have it.² Not only does OSA impact sleep quality, but in the long run the sleep condition increases the risk for cardiovascular morbidity and mortality.

Investigators conducted a prospective multicenter study to see if bariatric surgery, specifically laparoscopic Roux-en-Y gastric bypass, would affect OSA 5 years after the surgery.¹ To assess the change in OSA prevalence or the change in OSA severity, the team recruited patients between November 2010 – September 2013 from Vaasa Central Hospital (n = 103), Päijät-Häme Central Hospital (n = 46), and Kuopio University Hospital (n = 46). However, patients from Kuopio University Hospital were excluded as they did not have available 5-year data.

Inclusion criteria were the same as for bariatric surgery: aged 18 – 65 years, BMI > 35 with co-morbidity, or BMI > 40. Exclusion criteria included alcohol or drug abuse, severe eating disorder, severe psychiatric disorder, or other severe disease contra-indicating surgery.

Before bariatric surgery, the team conducted standard overnight cardiorespiratory recording by Embletta of 150 patients (60% women). In total, 91.7% of the males had OSA and 62.5% of females had OSA.

Additionally, patients completed symptom questionnaires for OSA, such as the Snore Outcomes Survey, Basic Nordic Sleep Questionnaire, Epworth Sleepiness Scale, and 15D quality of life questionnaires.

The team found 73.3% (n = 111) of patients had OSA. The cardiorespiratory recording was available for 102 patients after 1 year and 70 patients after 5 years. Investigators assessed changes in anthropometric and demographic measurements including age, weight, body mass index (BMI), and weight and neck circumference, and found there was a significant difference between all measures after 1 and 5 years compared to baseline (P < .001).

The team observed the mean weight reduced from 130.4 kg at baseline to 25.8% after 1 year and 22.2% after 5 years. BMI reduced from a mean of 44.5 kg/m2 to 11.5 kg/m2. They saw a significant relationship between improvement in total Apnea-Hypopnea Index (AHI) to weight loss.

At the 5-year follow-up, the mean total AHI reduced from 27.8 events/hour to 8.8 events per hour (P < .001). Investigators observed clinically significant difference in quality of life for mobility, breathing, sleeping, usual activities, discomfort and symptoms, vitality, and sexual activity. Patients had improvement in the quality-of-life total score 5 years after surgery.

Investigators highlighted a couple of limitations, including the fact only 60.7% of the 150 OSA patients at baseline had polysomnography at the 5-year follow-up, and of the patients who had polysomnography data 5 years later, more of them had OSA (63.1%).

Overall, bariatric surgery cured OSA in 55.1% of patients (AHI < 5). Of these patients, levels of OSA at baseline had been mild (60.5%), moderate (23.7%), and severe (15.8). Although 20% of patients still had moderate or severe OSA 5 years after the surgery, the results show bariatric surgery is an effective treatment of OSA for most obese patients.

“The [laparoscopic Roux-en-Y gastric bypass] is an effective treatment for OSA and beneficial outcome sustain at least for 5 years,” investigators concluded. “The postoperative cardiorespiratory recording is still recommended to identify 20% of patients with moderate to severe OSA after 5 years.”

^References

1. ^{Peromaa-Haavisto P, Luostarinen M, Juusela R, Tuomilehto H, Kössi J. Obstructive Sleep Apnea: The Effect of Bariatric Surgery After Five Years-A Prospective Multicenter Trial. Obes Surg. Published online March 8, 2024. doi:10.1007/s11695-024-07124-5}
2. ^{Could You Have Sleep Apnea Without Knowing It? Cleveland Clinic. November 14, 2023. https://health.clevelandclinic.org/sleep-apnea-its-waaaay-more-common-than-you-think. Accessed March 15, 2024.}