How Often Does Metabolic Surgery Cure Sleep Apnea?

Sleep apnea is a complication of obesity and at the same time, obesity can be a complication of sleep apnea. This two-way relationship sets up a problem that is serious and can be hard to resolve. But it deserves close attention because it can lead to an early death. So, given the tangled relationship between sleep apnea and obesity, an obvious question is how often does metabolic surgery – the most effective treatment we have for obesity – actually cure sleep apnea.

A new observational study in Obesity Surgery tells us that about half of a cohort of gastric bypass patients had a cure for their obstructive sleep apnea after five years.

Clearly, metabolic surgery is an effective treatment for both obesity and sleep apnea, but it’s not a guaranteed cure.

Limitations Everywhere

Everything about this subject confronts us with limitations. People with sleep apnea have limited options for treatment and those options are less than ideal.

This study has limitations because of its observational design and the polysomnography data the researchers collected. Nonetheless, it is quite an important study, as the authors explain:

“To our knowledge, this is the first study with reasonable number of patients evaluating the long-term effect of gastric bypass surgery on OSA. Our study demonstrates that bariatric surgery is an effective treatment of OSA even 5 years after the surgery. Three of five patients were considered to have been cured (i.e., they had an AHI < 5), and one out of every four (26.1%) patients were observed to have only mild OSA postoperatively. Furthermore, marked subjective improvements in the QoL were demonstrated.”

Some additional patients benefit, even if the don’t enjoy a complete cure for their condition. Researchers conclude that, in total, roughly 80% will benefit from the surgery.

Better Options Needed

That leaves one in five patients who still have moderate or severe apnea after surgery. So without a doubt, we need close follow-up and better options for these patients. One study to watch is SURMOUNT-OSA – an RCT of tirzepatide in patients with both sleep apnea and obesity. The study plan called for its completion in March and results will be presented in a symposium at the ADA Scientific Sessions in June.

Many people, perhaps 30 million or more, have sleep apnea and most of them are undiagnosed. In large part, that’s because the options for dealing with it are not great. Given that this is indeed a condition that can cut a person’s life short, we hope that new options will come to change this situation.

But for now, it certainly looks like metabolic surgery is a pretty good option that remains underutilized.

Click here for the study in Obesity Surgery and here for a new and very cogent review of obesity and obstructive sleep apnea.

Sleeping Woman, painting by Oskar Kokoschka / WikiArt

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April 6, 2024