Obstructive sleep apnea after weight loss: a clinical trial comparing gastric bypass and intensive lifestyle intervention

Abstract

Introduction: 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. Eighty-four 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 significantly 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 significantly 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 significant-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 beneficial effects.

Keywords: General; bariatric surgery; obstructive sleep apnea; weight loss.

Figure 1. Percentage of patients with specified AHI at baseline and after 1-year of treatment

Proportion of patients with an apnea-hypopnea index (AHI) ≥ 5 events/h and AHI ≥ 15 events/h, respectively, in 133 morbidly obese patients before (baseline) and after (1-year) treatment through an intensive lifestyle intervention (ILI) program or Roux-en-Y gastric bypass (RYGB) surgery.

Figure 2. Change in OSA category after treatment

Percentage distribution of change in OSA category (none, mild, moderate, or severe) of 84 morbidly obese OSA patients treated with either intensive lifestyle intervention (ILI, 40 patients) or Roux-en-Y gastric bypass surgery (RYGB, 44 patients).