Obstructive Sleep Apnea: The Effect of Bariatric Surgery After Five Years-A Prospective Multicenter Trial

Abstract

Background: The prevalence of obstructive sleep apnea (OSA) is high among the bariatric surgery candidates. Obesity is the most important individual risk factor for OSA. The aim of this study was to investigate the effect of a laparoscopic Roux-en-Y gastric bypass (LRYGB) on OSA 5 years after the surgery.

Patients and methods: In this prospective multicenter study, standard overnight cardiorespiratory recording was conducted to 150 patients at baseline prior to bariatric surgery. A total of 111 (73.3%) patients of those had OSA. Cardiorespiratory recordings at 5 years after surgery were available for 70 OSA patients. The changes in anthropometric and demographic measurements including age, weight, body mass index (BMI), and waist and neck circumference were evaluated. Also, a quality of life (QoL) questionnaire 15D administered in a baseline was controlled at 5-year follow-up visit.

Results: At 5-year OSA was cured in 55% of patients, but moderate or severe OSA still persisted in 20% of patients after operation. Mean total AHI decreased from 27.8 events/h to 8.8 events/h (p < 0.001) at 5-year follow-up. A clinically significant difference in QoL was seen in mobility, breathing, sleeping, usual activities, discomfort and symptoms, vitality and sexual activity. The QoL total score improved more in OSA patient at 5-year follow-up.

Conclusions: LRYGB is an effective treatment of OSA in obese patients and the achieved beneficial outcomes are maintained at 5-year follow-up.

Keywords: Bariatric surgery; Effect of bariatric surgery; Metabolic surgery; OSA; Obesity surgery; Obstructive sleep apnea.

Fig. 1

Estimated marginal means of total AHI preoperatively, 1 year and 5 years after operation in different groups stratified according to preoperative OSA status, p < 0.001 pre vs. 1 year and pre vs. 5 years, p = ns 1 year vs. 5 years (GLM repeated measures). Difference between no OSA and mild OSA p = ns., mild OSA vs. moderate OSA p = 0.027, all other between groups differences p < 0.001 (Tukey’s HSD post hoc test). Number of evaluated patients is 150 at baseline, 133 at 1 year, and 91 at 5 year. Difference between OSA groups were tested by Tukeys post hoc test

Fig. 2

Oxygen desaturation in minutes a < 90% and b < 80% preoperatively, at 1 year and at 5 years postoperatively in Embletta® monitoring. a In patients without OSA preoperatively, all differences were not significant. In patients with OSA preoperatively, p was < 0.001 for differences between preoperative and 1 year or 5 years desaturations and ns. for 1 year vs. 5 years. b In patients without OSA preoperatively, all differences were not significant. In patients with OSA preoperatively, p was < 0,05 for differences between preoperative and 1 year or 5 years desaturations and ns. for 1 year vs. 5 years. Number of evaluated patients is 150 at baseline, 133 at 1 year, and 91 at 5 years

Fig. 3

In OSA patients, improvement of total AHI correlated significantly with weight loss. (Pearson correlation 0.395, p < 0.001)

Fig. 4

15D quality of life instrument preoperatively and 5 years postoperatively in patients with preoperative obstructive sleep apnea (= OSA +) or without (= OSA-). Change more than 0.035 is regarded as clinically significant. Black star: Statistically and clinically significant improvement preoperative vs. 5 years in OSA + patients. Grey star: Statistically and clinically significant improvement preoperative vs. 5 years in OSA- patients. Grey circle: Statistically and clinically significant deterioration preoperative vs. 5 years in OSA- patients. Number of evaluated patients is 150 at baseline, 133 at 1 year, and 91 at 5 years