Obesity Surgery

, Volume 25, Issue 7, pp 1239–1250 | Cite as

Bariatric Surgery or Non-Surgical Weight Loss for Obstructive Sleep Apnoea? A Systematic Review and Comparison of Meta-analyses

  • Hutan Ashrafian
  • Tania Toma
  • Simon P. Rowland
  • Leanne Harling
  • Alan Tan
  • Evangelos Efthimiou
  • Ara Darzi
  • Thanos Athanasiou
Original Contributions
First Online:

Abstract

Background

Obstructive sleep apnoea (OSA) is a well-recognised complication of obesity. Non-surgical weight loss (medical, behavioural and lifestyle interventions) may improve OSA outcomes, although long-term weight control remains challenging. Bariatric surgery offers a successful strategy for long-term weight loss and symptom resolution.

Objectives

To comparatively appraise bariatric surgery vs. non-surgical weight loss interventions in OSA treatment utilising body mass index (BMI) and apnoea-hypopnoea index (AHI) as objective measures of weight loss and apnoea severity.

Methods

A systematic literature review revealed 19 surgical (n = 525) and 20 non-surgical (n = 825) studies reporting the primary endpoints of BMI and AHI before and after intervention. Data were meta-analysed using random effects modelling. Subgroup analysis, quality scoring and risk of bias were assessed.

Results

Surgical patients had a mean pre-intervention BMI of 51.3 and achieved a significant 14 kg/m2 weighted decrease in BMI (95%CI [11.91, 16.44]), with a 29/h weighted decrease in AHI (95%CI [22.41, 36.74]). Non-surgical patients had a mean pre-intervention BMI of 38.3 and achieved a significant weighted decrease in BMI of 3.1 kg/m2 (95%CI [2.42, 3.79]), with a weighted decrease in AHI of 11/h (95%CI [7.81, 14.98]). Heterogeneity was high across all outcomes.

Conclusions

Both bariatric surgery and non-surgical weight loss may have significant beneficial effects on OSA through BMI and AHI reduction. However, bariatric surgery may offer markedly greater improvement in BMI and AHI than non-surgical alternatives. Future studies must address the lack of randomised controlled and comparative trials in order to confirm the exact relationship between metabolic surgery and non-surgical weight loss interventions in OSA resolution.

Keywords

Obstructive sleep apnoea Body mass index Intervention Surgery Weight loss Apnoea-hypopnoea index 
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Notes

Ethical Approval

For this type of study, formal consent is not required.

Conflict of Interest

The authors declare that they have no conflict of interest.

Financial Disclosure

None

Supplementary material

11695_2014_1533_MOESM1_ESM.doc (436 kb)
ESM 1 Funnel Plot assessment of publication bias: (a) BMI surgical group; (b) BMI non-surgical group; (c) AHI surgical group; (d) AHI non-surgical group. Dashed lines represent means and 95 % confidence intervals. (DOC 436 kb)
11695_2014_1533_MOESM2_ESM.doc (29 kb)
ESM 2 Criteria for quality assessment (DOC 29 kb)
11695_2014_1533_MOESM3_ESM.doc (74 kb)
ESM 3 Quality Scoring (DOC 74 kb)
11695_2014_1533_MOESM4_ESM.doc (40 kb)
ESM 4 Eggers Test for Funnel Plot Asymmetry (DOC 40 kb)

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Hutan Ashrafian
    • 1
  • Tania Toma
    • 1
  • Simon P. Rowland
    • 1
  • Leanne Harling
    • 1
  • Alan Tan
    • 1
  • Evangelos Efthimiou
    • 1
  • Ara Darzi
    • 1
  • Thanos Athanasiou
    • 1
  1. 1.The Department of Surgery and Cancer, Imperial College London. 10th Floor, Queen Elizabeth the Queen Mother (QEQM) BuildingImperial College Healthcare NHS Trust at St Mary’s HospitalLondonUK

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