Predictive Factors for Insufficient Weight Loss After Bariatric Surgery: Does Obstructive Sleep Apnea Influence Weight Loss?

Jul 30, 2015Obesity surgery

Factors That Predict Poor Weight Loss After Bariatric Surgery and Whether Sleep Apnea Affects It

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Abstract

After 1 year, patients with obstructive sleep apnea (OSA) achieved 65.5% excess weight loss compared to 70.3% in non-OSA patients.

Obstructive sleep apnea (OSA) is present in 64% of the 816 patients reviewed for weight loss after bariatric surgery.
Patients with severe OSA experienced the lowest percentage of excess weight loss (61.7%).
No significant impact of OSA on percentage excess weight loss or body mass index changes was observed when adjusted for waist circumference, BMI, and age.
Several factors, including age, gender, and type II diabetes, are associated with insufficient weight loss (defined as ≤50% excess weight loss), with an area under the curve of 0.778 indicating predictive value.

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BACKGROUND: Important endpoints of bariatric surgery are weight loss and improvement of comorbidities, of which obstructive sleep apnea (OSA) is the highest accompanying comorbidity (70%). This study aimed to evaluate the influence of OSA on weight loss after bariatric surgery and to provide predictive factors for insufficient weight loss (defined as ≤50% excess weight loss (EWL)) at 1 year follow-up.

METHODS: All consecutive patients, who underwent primary laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy between 2006 and 2014 were retrospectively reviewed. Patients with data on preoperative apnea-hypopnea index (AHI) and pre- and postoperative body mass index (BMI) were included. After surgery, the percentage excess weight loss (%EWL) and BMI changes were compared between preoperatively diagnosed OSA-, subdivided in mild, moderate, and severe OSA, and non-OSA patients. Multivariable logistic regression analysis evaluated predictive factors for ≤50% EWL.

RESULTS: A total of 816 patients, 522 (64%) with and 294 (36%) without OSA, were included. After 1 year, OSA patients achieved less %EWL than non-OSA patients (65.5 SD 20.7 versus 70.3 SD 21.0; p < 0.01). The lowest %EWL was seen in severe OSA patients (61.7 SD 20.2). However, when adjusted for waist circumference, BMI, and age, no effect of OSA was seen on %EWL or changes in BMI. Although AHI, gender, age, BMI, type of surgery, and type II diabetes were predictive factors for ≤50% EWL (area under the curve 0.778), the AHI as variable was of little importance.

CONCLUSIONS: The presence of OSA does not individually impair weight loss after bariatric surgery.

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Predictive Factors for Insufficient Weight Loss After Bariatric Surgery: Does Obstructive Sleep Apnea Influence Weight Loss?

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