Obstructive Sleep Apnea after Weight Loss: A Clinical Trial Comparing Gastric Bypass and Intensive Lifestyle Intervention

May 16, 2013Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

Obstructive sleep apnea after weight loss: comparing gastric bypass surgery and intense lifestyle changes

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Abstract

A total of 133 morbidly obese subjects showed that Roux-en-Y gastric bypass (RYGB) resulted in a 30% average weight loss compared to 8% in the intensive lifestyle intervention (ILI) group.

Sixty-three percent of participants had obstructive sleep apnea (OSA) at baseline.
Both treatment groups experienced a reduction in the apnea-hypopnea index (AHI), with RYGB showing a greater decrease (mean AHI change -13.1) compared to ILI (-6.0).
Remission of OSA occurred in 66% of RYGB patients versus 40% of ILI patients.
RYGB patients had lower adjusted odds for OSA compared to ILI patients after controlling for age, gender, and baseline AHI.
When adjusting for changes in body mass index (BMI), the difference in odds between treatment groups was no longer statistically significant.

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INTRODUCTION: Few studies have compared the effect of surgical and conservative weight loss strategies on obstructive sleep apnea (OSA). We hypothesized that Roux-en-Y gastric bypass (RYGB) would be more effective than intensive lifestyle intervention (ILI) at reducing the prevalence and severity of OSA (apnea-hypopnea-index [AHI] ≥ 5 events/hour).

METHODS: A total of 133 morbidly obese subjects (93 females) were treated with either a 1-year ILI-program (n = 59) or RYGB (n = 74) and underwent repeated sleep recordings with a portable somnograph (Embletta).

RESULTS: Participants had a mean (SD) age of 44.7(10.8) years, BMI 45.1(5.7) kg/m(2), and AHI 17.1(21.4) events/hour. Eighty-four patients (63%) had OSA. The average weight loss was 8% in the ILI-group and 30% in the RYGB-group (p < 0.001). The mean (95%CI) AHI reduced in both treatment groups, although significantly more in the RYGB-group (AHI change -6.0 [ILI] vs -13.1 [RYGB]), between group difference 7.2 (1.3, 13.0), p = 0.017. Twenty-nine RYGB-patients (66%) had remission of OSA, compared to 16 ILI-patients (40%), p = 0.028. At follow-up, after adjusting for age, gender, and baseline AHI, the RYGB-patients had significantly lower adjusted odds for OSA than the ILI-patients-OR (95% CI) 0.33 (0.14, 0.81), p = 0.015. After further adjustment for BMI change, treatment group difference was no longer statistically significant-OR (95% CI) 1.31 (0.32, 5.35), p = 0.709.

CONCLUSION: Our study demonstrates that RYGB was more effective than ILI at reducing the prevalence and severity of OSA. However, our analysis also suggests that weight loss, rather than the surgical procedure per se, explains the beneficial effects.

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Obstructive Sleep Apnea after Weight Loss: A Clinical Trial Comparing Gastric Bypass and Intensive Lifestyle Intervention

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