Journal Article

Bariatric Surgery or Non-Surgical Weight Loss for Obstructive Sleep Apnoea? A Systematic Review and Comparison of Meta-analyses

Toma, Tania, Rowland, Simon P., Harling, Leanne, Tan, Alan, Efthimiou, Evangelos, Athanasiou, Thanos, Ashrafian, Hutan, Darzi, Ara

2015

Overview

Background Obstructive sleep apnoea (OSA) is a well-recognised complication of obesity. Non-surgical weight loss (medical, behavioural and lifestyle interventions) may improve OSA outcomes, although long-term weight control remains challenging. Bariatric surgery offers a successful strategy for long-term weight loss and symptom resolution. Objectives To comparatively appraise bariatric surgery vs. non-surgical weight loss interventions in OSA treatment utilising body mass index (BMI) and apnoea-hypopnoea index (AHI) as objective measures of weight loss and apnoea severity. Methods A systematic literature review revealed 19 surgical ( n  = 525) and 20 non-surgical ( n  = 825) studies reporting the primary endpoints of BMI and AHI before and after intervention. Data were meta-analysed using random effects modelling. Subgroup analysis, quality scoring and risk of bias were assessed. Results Surgical patients had a mean pre-intervention BMI of 51.3 and achieved a significant 14 kg/m 2 weighted decrease in BMI (95%CI [11.91, 16.44]), with a 29/h weighted decrease in AHI (95%CI [22.41, 36.74]). Non-surgical patients had a mean pre-intervention BMI of 38.3 and achieved a significant weighted decrease in BMI of 3.1 kg/m 2 (95%CI [2.42, 3.79]), with a weighted decrease in AHI of 11/h (95%CI [7.81, 14.98]). Heterogeneity was high across all outcomes. Conclusions Both bariatric surgery and non-surgical weight loss may have significant beneficial effects on OSA through BMI and AHI reduction. However, bariatric surgery may offer markedly greater improvement in BMI and AHI than non-surgical alternatives. Future studies must address the lack of randomised controlled and comparative trials in order to confirm the exact relationship between metabolic surgery and non-surgical weight loss interventions in OSA resolution.

• Publisher: Springer US,Springer Nature B.V
• Subject: Bariatric Surgery / Body Mass Index / Gastrointestinal surgery / Humans / Life Style / Medicine / Medicine & Public Health / Obesity / Obesity, Morbid - complications / Obesity, Morbid - surgery / Obesity, Morbid - therapy / Original Contributions / Sleep apnea / Sleep Apnea, Obstructive - etiology / Sleep Apnea, Obstructive - surgery / Sleep Apnea, Obstructive - therapy / Surgery / Systematic review / Treatment Outcome / Weight control / Weight Loss