Sleeping Muse

Sleep Apnea, Metabolic Surgery, and the Risk of Death

At the ASMBS Annual Meeting this week, a new study of major bad outcomes in people with both obesity and sleep apnea reminds us why metabolic surgery remains an important option for comprehensive obesity care. The risk of death, heart attacks, strokes, and other major bad cardiovascular outcomes is 37 percent lower if a person with obesity and sleep apnea has surgery.

Using a CPAP machine – the standard therapy for sleep apnea – provides symptomatic relief, but it has no effect on these major outcomes.

Ten Years of Observational Data

These findings come from a ten-year study of 970 metabolic surgery patients with both sleep apnea and obesity with BMI in the range of 35 to 70. The non-surgical control group included 12,687 persons. To help with the inference of causality, statistical methods for the study used a doubly robust estimation that combined the overlap weighting and multivariable-adjusted Cox regression. Ali Aminian and colleagues precisely balanced the distribution of 15 baseline covariates between study groups after overlap weighting.

Aminian pointed out the importance of these findings:

“No other therapy has been shown to reduce the risk of dying or developing heart attack or heart failure in patients with obesity and obstructive sleep apnea. Bariatric surgery is a very powerful tool that can help patients with sleep apnea live longer and healthier lives.”

Symptomatic Relief?

Both standard therapy with CPAP and metabolic surgery can provide symptomatic relief from sleep apnea. Both interventions serve to reduce daytime sleepiness. But this new study and other evidence reminds us that only surgery offers the potential for important improvements in long-term health outcomes. Preventing early deaths, heart attacks, and strokes seems rather important. A CPAP machine does not do this.

Yet, we note that the use of CPAP therapy is more common and more vigorously recommended than metabolic surgery. The unwarranted stigma linked to bariatric surgery might explain this irrational imbalance.

Data such as these, sure to be published with full peer review soon, should help overcome this. These outcomes lead us to believe that despite the advent of highly effective obesity medicines, metabolic surgery will remain an important part of obesity care for some time to come.

Click here for the abstract of this research, here and here for further reporting on this study. For a new systematic review and meta-analysis of metabolic surgery and sleep apnea, click here.

Sleeping Muse, sculpture by Constantin Brâncuși / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


June 30, 2023