The impact of bariatric surgery on obstructive sleep apnea: A systematic review

Kourosh Sarkhosh, MD, Noah J Switzer, Mustafa El-Hadi, MD, Daniel Birch, MD, Xinzhe Shi, MPH, Shahzeer Karmali, MD

Center for the Advancement of Minimally Invasive Surgery (CAMIS), University of Alberta Faculty of Medicine and Dentistry, Department of Surgery, University of Alberta

Abstract:
Obesity rates are steadily increasing worldwide. There is a strong relationship that exists between obesity and the development of obstructive sleep apnea (OSA). OSA goes beyond merely a disorder of excessive daytime sleepiness and sleep disturbance, as it has important long-term sequelae in the development of the metabolic syndrome, which can lead to tremendous patient morbidity. It is well understood that metabolic surgery, as a whole, is the most effective option for managing and treating obesity and its comorbidities, including OSA. However, there remains a paucity of data in the literature of the comparison and evaluation of all the specific types of bariatric surgery themselves. A systematic review was performed, to determine, of the available bariatric procedures [Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), or biliopancreatic diversion (BPD)], which procedures were the most efficacious in the treatment of OSA. A total of 67 studies with 13,900 patients were included in the review. It was found that all procedures achieved significant mean excessive weight-loss above 40%, with RYGB achieving the highest weight-loss (75%). As well, all the procedures achieved profound effects on OSA, as over 75% of patients saw at least an improvement in their sleep apnea post-bariatric surgery. BPD was the most successful bariatric procedure in improving or resolving OSA, with LAGB being the least. It appeared that malabsorptive procedures were more successful in achieving clinically significant effects on OSA compared with restrictive procedures. This was postulated to be due to alterations in gut anatomy and hormones, as well as to a reduction in low-level systemic inflammation, but still more studies are needed to be devoted to the exact physiological mechanism that accounts for the impressive action of malabsorptive procedures on OSA. It can be confidently concluded that bariatric surgery is a definitive treatment for obstructive sleep apnea, regardless of the specific type.

Session: Poster Presentation

Program Number: P468