Effects of Surgical Weight Loss on Measures of Obstructive Sleep Apnea: A Meta-Analysis

Greenburg, David; Lettieri, Christopher J.; Eliasson, Arn H.

doi:10.1016/j.amjmed.2008.10.037

Cited by 336 publications

(188 citation statements)

References 35 publications

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“…fatal and nonfatal cardiovascular events in patients with OSA 9) . In addition, bariatric surgery significantly reduces AHI and improves the severity of OSA by significantly reducing BMI 27) . However, it is thought that weight reduction alone based on lifestyle modification has little effect on improving OSA due to a lack of well-executed studies of OSA.…”

Section: Discussionmentioning

confidence: 99%

Effects of Weight Reduction Therapy on Obstructive Sleep Apnea Syndrome and Arterial Stiffness in Patients with Obesity and Metabolic Syndrome

Iguchi

Tochiya

Muranaka

et al. 2013

JAT

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Aim: Obesity and metabolic syndrome (MetS) and obstructive sleep apnea (OSA), which are often accompanied by obesity, are each independently associated with cardiovascular disease (CVD). However, the influence of OSA on arterial stiffness in obese patients remains unclear. We herein examined the relationships between the severity of OSA and CVD risk factors, including the severity of MetS and arterial stiffness, in obese patients. In addition, we evaluated the effects of weight reduction therapy on OSA and arterial stiffness.

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Section: Discussionmentioning

confidence: 99%

Effects of Weight Reduction Therapy on Obstructive Sleep Apnea Syndrome and Arterial Stiffness in Patients with Obesity and Metabolic Syndrome

Iguchi

Tochiya

Muranaka

et al. 2013

JAT

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“…8,9 In accordance with our findings, a recent metaanalysis of 12 studies focusing on the effects of bariatric surgery reported an average 71% reduction in AHI events. 12 The ILI patients reduced their weight by approximately 10% and their AHI by approximately 40%. This also corresponds well with the findings of a study that found a 50% reduction in AHI when patients reduced their body weight by 10% to 15%.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, some surgically treated patients will still be in need of continued CPAP treatment. 12 In another metaanalysis the authors were unable to conclude whether surgically induced weight loss was associated with greater improvements in OSA than conservative treatment. 13 Further, it remains unknown whether RYGB may influence the severity of OSA through a mechanism other than weight loss.…”

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confidence: 99%

Obstructive Sleep Apnea after Weight Loss: A Clinical Trial Comparing Gastric Bypass and Intensive Lifestyle Intervention

Fredheim

Rollheim

Sandbu

et al. 2013

Journal of Clinical Sleep Medicine

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I ntroduction: Few studies have compared the effect of surgical and conservative weight loss strategies on obstructive sleep apnea (OSA). We hypothesized that Roux-en-Y gastric bypass (RYGB) would be more effective than intensive lifestyle intervention (ILI) at reducing the prevalence and severity of OSA (apnea-hypopnea-index [AHI] ≥ 5 events/hour). Methods: A total of 133 morbidly obese subjects (93 females) were treated with either a 1-year ILI-program (n = 59) or RYGB (n = 74) and underwent repeated sleep recordings with a portable somnograph (Embletta). Results: Participants had a mean (SD) age of 44.7(10.8) years, BMI 45.1(5.7) kg/m 2 , and AHI 17.1(21.4) events/hour. Eightyfour patients (63%) had OSA. The average weight loss was 8% in the ILI-group and 30% in the RYGB-group (p < 0.001). The mean (95%CI) AHI reduced in both treatment groups, although signifi cantly more in the RYGB-group (AHI change -6.0 [ILI] vs -13.1 [RYGB]), between group difference 7.2 (1.3, 13.0), p = 0.017. Twenty-nine RYGB-patients (66%) had remission of OSA, compared to 16 ILI-patients (40%), p = 0.028. At follow-up, after adjusting for age, gender, and baseline AHI, the RYGB-patients had signifi cantly lower adjusted odds for OSA than the ILI-patients-OR (95% CI) 0.33 (0.14, 0.81), p = 0.015. After further adjustment for BMI change, treatment group difference was no longer statistically signifi cant-OR (95% CI) 1.31 (0.32, 5.35), p = 0.709. Conclusion: Our study demonstrates that RYGB was more effective than ILI at reducing the prevalence and severity of OSA. However, our analysis also suggests that weight loss, rather than the surgical procedure per se, explains the benefi cial effects. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea (OSA) is a commonly unrecognized condition with an especially high prevalence among morbidly obese subjects.1,2 OSA is characterized by apneas and hypopneas due to the collapse of upper airways and is defi ned by ≥ 5 apneas or hypopneas per hour during sleep, as measured by the apnea-hypopnea index (AHI). Mild OSA is defi ned as 5-15 episodes of apneas or hypopneas per hour, moderate OSA 15-30, and severe OSA ≥ 30. A metaanalysis from 2009 concluded that continuous positive airway pressure (CPAP) is a cost-effective treatment of OSA and that it reduces daytime sleepiness compared to placebo or usual care.3 Accordingly, CPAP is the fi rst-line treatment and is recommended for all patients with moderate to severe OSA (AHI ≥ 15). Obesity, older age, male sex, and heredity are well-established risk factors for OSA, 5 with obesity being the single most important modifi able risk factor. In cases of obesity, fat deposits narrow the upper airways, and abdominal fat masses decrease the tracheal tension, both increasing the collapsibility of the upper airways. If untreated, OSA is associated with increased risk of diabetes, cardiovascular disease, driving accidents, and allcause mortality. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Weight reduction reduces the severity of OSA in ...

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“…For example, in patients with obstructive sleep apnea (OSA), bariatric surgery significantly reduces the apnea-hypopnea index but a residual impairment is likely to persist; patients should not expect a cure of OSA after bariatric surgery and are likely to need continued treatment to minimize complications [28].…”

Section: Does Bariatric Surgery Provide Sustained Weight Control?mentioning

confidence: 99%

Informed Decision-Making for Bariatric Surgery: Benefits, Risks, Uncertainties and Choices

Sarela

2014

Indian J Surg

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Decision-making is a critical aspect of good surgical care, and this principle is particularly important in bariatric surgery. Adequate communication of information to patients is essential in order to facilitate optimal uptake of bariatric surgery and choice of the most suitable procedure. This article reviews the most relevant advances in understanding of longterm efficacy associated with gastric banding, gastric bypass and sleeve gastrectomy.

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Effects of Surgical Weight Loss on Measures of Obstructive Sleep Apnea: A Meta-Analysis

Cited by 336 publications

References 35 publications

Effects of Weight Reduction Therapy on Obstructive Sleep Apnea Syndrome and Arterial Stiffness in Patients with Obesity and Metabolic Syndrome

Effects of Weight Reduction Therapy on Obstructive Sleep Apnea Syndrome and Arterial Stiffness in Patients with Obesity and Metabolic Syndrome

Obstructive Sleep Apnea after Weight Loss: A Clinical Trial Comparing Gastric Bypass and Intensive Lifestyle Intervention

Informed Decision-Making for Bariatric Surgery: Benefits, Risks, Uncertainties and Choices

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