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.
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.
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.
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.
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.
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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)
Criteria for quality assessment (DOC 29 kb)
Quality Scoring (DOC 74 kb)
Eggers Test for Funnel Plot Asymmetry (DOC 40 kb)
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Ashrafian, H., Toma, T., Rowland, S.P. et al. Bariatric Surgery or Non-Surgical Weight Loss for Obstructive Sleep Apnoea? A Systematic Review and Comparison of Meta-analyses. OBES SURG 25, 1239–1250 (2015). https://doi.org/10.1007/s11695-014-1533-2
- Obstructive sleep apnoea
- Body mass index
- Weight loss
- Apnoea-hypopnoea index