Metabolic surgery improves obstructive sleep apnoea severity, but heterogeneity and a lack of comparative studies preclude definitive conclusions regarding its benefits over non-surgical therapy.
Meta-Analysis
Does metabolic or bariatric surgery improve body mass index and sleep apnoea severity compared to non-surgical weight loss in morbidly obese individuals with obstructive sleep apnoea?
While metabolic surgery improves OSA symptoms and metabolic profiles, current literature heterogeneity and lack of comparative studies prevent definitive conclusions on its superiority over non-surgical weight loss.
The global epidemic of obesity and the worldwide prevalence of obstructive sleep apnoea (OSA) are both increasing. Epidemiological studies reveal an association between obesity, weight gain and OSA. Metabolic or bariatric operations provide sustained weight loss and resolve or improve the symptoms of OSA in the majority of morbidly obese individuals. These operations also modulate the metabolic profile to improve glycaemic control, to decrease cardiovascular risk and obesity-related mortality. The beneficial effects of metabolic operations on OSA include mechanical weight-dependent and metabolic weight-independent effects that are achieved through the BRAVE effects: (Bile flow alteration; Reduction of gastric size; Anatomical gut rearrangement and altered flow of nutrients; Vagal manipulation; and Enteric gut hormone modulation). These result in an improvement in insulin resistance, adipokines, cytokines and systemic inflammation. A literature analysis was performed with statistical pooling of available surgical and medical studies to determine whether the weighted mean decrease in body mass index and sleep apnoea severity (measured by the apnoea-hypopnoea index) are larger in metabolic surgical studies than in non-surgical weight loss studies (diet, exercise and medication). However, heterogeneity across available trials, poor follow-up measures and a deficiency in comparative studies between surgical and non-surgical therapy precludes definitive statements regarding the relative benefits of surgical therapy. Further research is required to quantify robustly the effects and mechanisms of sleep apnoea resolution by metabolic surgery, which may reveal novel non-surgical treatments or enhanced surgical strategies in the management of this multisystem sleep disorder.
Ashrafian et al. (Mon,) conducted a meta-analysis in Obstructive sleep apnoea and obesity. Metabolic surgery vs. Non-surgical weight loss (diet, exercise and medication) was evaluated on Decrease in body mass index and sleep apnoea severity (apnoea-hypopnoea index). Metabolic surgery improves obstructive sleep apnoea severity, but heterogeneity and a lack of comparative studies preclude definitive conclusions regarding its benefits over non-surgical therapy.