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Bariatric surgery and OSA

Surgery has clear role for treating OSA in patients with morbid obesity

At the end of the study 14 patients no longer required CPAP and were discharged from the sleep clinic (29.8%)

Bariatric surgery has a clear role in treating patients with obstructive sleep apnoea (OSA) and should be routinely recommended for curative benefit in patients with morbid obesity, according to researchers from Worcestershire Acute Hospitals NHS Trust, Worcester, UK. The researchers, who analysed in effects of surgery of both laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG), reported that that 55.3% of patients had resolution or improvement in OSA following surgery.

The paper, ‘The impact of bariatric surgery on the resolution of obstructive sleep apnoea’, published in BMC Research Notes, stated that there is inconclusive evidence on the efficacy of bariatric surgery for treating OSA. Therefore, the researchers used objective measurements to determine the rate of resolution or improvement of OSA in patients who had bariatric procedures in their unit.

They conducted a retrospective review of the prospectively maintained database of all patients between June 2012 and September 2016 who had bariatric surgery and were diagnosed with OSA. They recorded demographic details, start weight and BMI, end weight and BMI, % excess weight loss (EWL), pre- and post-operative AHI, requirement for CPAP therapy with start and end (if applicable) pressure settings. Duration of follow-up and any losses to follow-up were also recorded.

Outcomes

In total, of the 176 patients in the database 47 were formally diagnosed with OSA (26.7%, 63.8% of patients were female with a mean age of 48.5 years). There were 25 patients who received LRYGB and 22 who had a LSG. There were no significant differences in age, sex or start weight and BMI between the LRYGB and LSG groups. Patients with type 2 diabetes mellitus were more likely to have the Roux-en-Y gastric bypass procedure.

Forty-three patients required nocturnal continuous positive airway pressure (CPAP) therapy and pre-operative AHI (whilst on CPAP therapy) and CPAP settings were available for 38 patients. There was a trend towards a higher starting AHI in the LSG group (4.7±4.7 events/h vs with 8.7±7.1 events/h, p=0.049), although CPAP settings were similar for both groups (11.8±3.0cmH2O in the vs 10.7 ± 2.3 cmH2O, p=0.019).

Mean duration of follow-up was 15.6±10.6 months and 12 patients were lost to sleep clinic follow-up (25.5%) – ten did not attend scheduled appointments and two were non-adherent with the CPAP device and sleep clinic instructions.

At the end of the study period, mean excess weight loss was 56.2±14.2% (average 39.6kg weight loss) with a mean BMI36.4±5.7. There was a significant decrease in the mean AHI post-operatively (p<0.0001). Fourteen patients no longer required CPAP and were discharged from the sleep clinic (29.8%). A further 12 showed partial resolution with marked decreases in AHI and CPAP pressure settings, while nine (19.1%) showed no objective improvement in settings (Table 1). At the end of the study period, 21 patients were still on CPAP therapy (44.7%) vs with 91.5% at the beginning.

Table 1: Objective measurements pre- and post-operatively

Mean EWL was greater in the LRYGB group vs the LSG group (p=0.036) and end AHI was lower in this group (p=0.039). There were no other significant differences between the two groups. There was no significant association found between EWL and end AHI or CPAP settings (p=0.17), between EWL and end CPAP (p=0.20).

“In summary, this study shows a clear benefit of Bariatric surgery to a group of patients with an established obesity-associated metabolic disorder with associated morbidity and mortality and costs from ongoing therapy,” they concluded. “This adds to the body of literature supporting the role of Bariatric surgery in treating sleep apnoea and we believe that it should be routinely recommended for curative benefit in this patient group.”

To access this paper, please click here

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