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

Dec 25, 2014Obesity surgery

Bariatric Surgery Versus Non-Surgical Weight Loss for Obstructive Sleep Apnea: A Comparison of Reviews

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Abstract

Surgical patients had a mean pre-intervention BMI of 51.3 and achieved a significant 14 kg/m² decrease in BMI.

Bariatric surgery resulted in a significant decrease in the apnoea-hypopnoea index (AHI) by 29 events/hour.
Non-surgical weight loss interventions led to a decrease in BMI of 3.1 kg/m² and a reduction in AHI by 11 events/hour.
Both treatment approaches may improve obstructive sleep apnoea (OSA) outcomes by reducing BMI and AHI.
The improvements in BMI and AHI were significantly greater for bariatric surgery compared to non-surgical methods.
High heterogeneity was noted across all outcomes, indicating variability in results among studies.

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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.

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

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