A study conducted by the Cleveland Clinic showed that bariatric surgery, performed on patients with obesity and moderate to severe obstructive sleep apnea, was associated with a significantly lower risk of death and adverse cardiovascular events, compared to patients who did not undergo surgery.
The study was published in the Journal of the American College of Cardiology.
“Research shows that weight loss, achieved by… “Bariatric surgery was associated with a 42% reduction in adverse cardiovascular events and a 37% reduction in the risk of death in patients with obesity and moderate to severe obstructive sleep apnea.”
A study published in the Lancet Respiratory Medicine journal showed that about one billion adults around the world suffer from obstructive sleep apnea, and obesity is considered one of the most prominent risk factors in the development of obstructive sleep apnea. For its part, the Obesity Medicine Society indicates that about 70% of adult patients who suffer from obstructive sleep apnea are obese.
Life-threatening diseases
People with obstructive sleep apnea, which can disrupt metabolism and lead to further obesity, are at increased risk for life-threatening conditions such as heart attacks and heart failure. The Metabolic Surgery for Sleep Apnea and Cardiovascular Disease study is the first to provide data on the long-term cardiovascular outcomes of bariatric surgery in patients with obstructive sleep apnea and obesity.
The study included 13,657 adult patients with a body mass index ranging between 35-70 and suffering from moderate to severe obstructive sleep apnea (diagnosed after a sleep test), during the period between 2004-2018. Baseline clinical characteristics of 970 patients who underwent bariatric surgery were balanced with 12,687 patients in the non-surgical control group using nested weighting methods. Follow-ups for the study ended in September 2022.
The results showed at the end of the study that the cumulative incidence rate of major adverse cardiovascular events over a 10-year period was 27% in the bariatric surgery group and 35.6% in the non-surgical group.
cardiovascular event
A major adverse cardiovascular event is defined as a first coronary event, cerebrovascular events, heart failure, atrial fibrillation, and all-cause mortality. Additional analysis showed that the cumulative all-cause mortality rate at 10 years was 9.1% in the bariatric surgery group and 12.5% in the nonsurgical group.
“There are currently no approved drug treatments for obstructive sleep apnea,” said Dr. Steven Nissen, chief academic officer of the Cardiovascular and Thoracic Institute at Cleveland Clinic and co-first author of the study. Before the Metabolic Surgery for Obstructive Sleep Apnea study Sleep and Cardiovascular Disease (MOSAIC), “No treatment has shown a reduction in the risk of major adverse cardiovascular events and death in patients with sleep apnea.”
At 10 years, patients in the bariatric surgery group lost an average of 33.2 kilograms (77.6 pounds), while patients in the non-surgery group lost an average of 6.64 kilograms (14.4 pounds). Patients in the bariatric surgery group maintained at least 25 percent of their weight loss for 10 years after surgery.
Lifestyle modification
For her part, Dr. Nancy Foldvari-Schafer, director of the Sleep Disorders Center at Cleveland Clinic, said, “Current guidelines for managing obstructive sleep apnea recommend losing weight and making lifestyle modifications.”
The results of the Metabolic Surgery for Sleep Apnea and Cardiovascular Disease (MOSAIC) study support these recommendations, but rather than focusing on lifestyle modifications alone, there is a need to treat obesity with more effective and sustainable methods such as bariatric surgery to improve cardiovascular outcomes and survival rates in patients with obstructive sleep apnea and obesity.”
“Bariatric surgery is life-saving in some patients,” Dr. Aminian concluded. “MOSAIC indicates that there is a dose-dependent response between the amount of weight loss and the benefits achieved.” As for the heart and blood vessels in patients who suffer from obstructive sleep apnea, the greater the weight loss, the lower the risk of heart complications, coinciding with the emergence of a new generation of obesity medications, which can achieve an average weight reduction of between 15 and 15. 20%, it has become theoretically possible to obtain similar results from medical treatments.”