Adverse Cardiovascular Outcomes in Patients With Obstructive Sleep Apnea and Obesity

Jun 23, 2024Journal of the American College of Cardiology

Worse Heart Problems in People with Sleep Apnea and Obesity: Comparing Weight-Loss Surgery to Regular Treatment

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Abstract

The 10-year cumulative incidence of major adverse cardiovascular events (MACE) was 27.0% in the metabolic surgery group compared to 35.6% in the nonsurgical group.

Patients undergoing metabolic surgery experienced a mean weight loss of 26.6 kg over 10 years.
The adjusted hazard ratio for incident MACE in the metabolic surgery group was 0.58, indicating a lower risk compared to the nonsurgical group.
All-cause mortality at 10 years was 9.1% in the metabolic surgery group, compared to 12.5% in the nonsurgical group.
The adjusted hazard ratio for all-cause mortality was 0.63 for the metabolic surgery group, suggesting reduced mortality risk.
Findings indicate that metabolic surgery may provide significant long-term benefits for patients with obstructive sleep apnea and obesity.

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BACKGROUND: No therapy has been shown to reduce the risk of major adverse cardiovascular events (MACE) and death in patients with obstructive sleep apnea (OSA).

OBJECTIVES: The authors sought to investigate the long-term relationship between metabolic surgery and incident MACE in patients with OSA and obesity.

METHODS: Adult patients with a body mass index 35 to 70 kg/mand moderate-to-severe OSA at a U.S. health system (2004-2018) were identified. Baseline characteristics of patients who underwent metabolic surgery were balanced with a nonsurgical control group using overlap-weighting methods. Multivariable Cox regression analysis estimated time-to-incident MACE. Follow-up ended in September 2022. 2

RESULTS: A total of 13,657 patients (7,496 [54.9%] men; mean age 52.0 ± 12.4 years; median body mass index 41.0 kg/m[Q1-Q3: 37.6-46.2 kg/m]), including 970 patients in the metabolic surgery group and 12,687 patients in the nonsurgical group, with a median follow-up of 5.3 years (Q1-Q3: 3.1-8.4 years) were analyzed. The mean between-group difference in body weight at 10 years was 26.6 kg (95% CI: 25.6-27.6 kg) or 19.3% (95% CI: 18.6%-19.9%). The 10-year cumulative incidence of MACE was 27.0% (95% CI: 21.6%-32.0%) in the metabolic surgery group and 35.6% (95% CI: 33.8%-37.4%) in the nonsurgical group (adjusted HR: 0.58 [95% CI: 0.48-0.71]; P < 0.001). The 10-year cumulative incidence of all-cause mortality was 9.1% (95% CI: 5.7%-12.4%) in the metabolic surgery group and 12.5% (95% CI: 11.2%-13.8%) in the nonsurgical group (adjusted HR: 0.63 [95% CI: 0.45-0.89]; P = 0.009). 2 2

CONCLUSIONS: Among patients with moderate-to-severe OSA and obesity, metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident MACE and death.

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