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Predictive Factors for Insufficient Weight Loss After Bariatric Surgery: Does Obstructive Sleep Apnea Influence Weight Loss?



Important endpoints of bariatric surgery are weight loss and improvement of comorbidities, of which obstructive sleep apnea (OSA) is the highest accompanying comorbidity (70 %). This study aimed to evaluate the influence of OSA on weight loss after bariatric surgery and to provide predictive factors for insufficient weight loss (defined as ≤50 % excess weight loss (EWL)) at 1 year follow-up.


All consecutive patients, who underwent primary laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy between 2006 and 2014 were retrospectively reviewed. Patients with data on preoperative apnea-hypopnea index (AHI) and pre- and postoperative body mass index (BMI) were included. After surgery, the percentage excess weight loss (%EWL) and BMI changes were compared between preoperatively diagnosed OSA-, subdivided in mild, moderate, and severe OSA, and non-OSA patients. Multivariable logistic regression analysis evaluated predictive factors for ≤50 % EWL.


A total of 816 patients, 522 (64 %) with and 294 (36 %) without OSA, were included. After 1 year, OSA patients achieved less %EWL than non-OSA patients (65.5 SD 20.7 versus 70.3 SD 21.0; p < 0.01). The lowest %EWL was seen in severe OSA patients (61.7 SD 20.2). However, when adjusted for waist circumference, BMI, and age, no effect of OSA was seen on %EWL or changes in BMI. Although AHI, gender, age, BMI, type of surgery, and type II diabetes were predictive factors for ≤50 % EWL (area under the curve 0.778), the AHI as variable was of little importance.


The presence of OSA does not individually impair weight loss after bariatric surgery.

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Fig. 1



Apnea-hypopnea index


Body mass index


Continuous positive airway pressure

(%) EWL:

Percentage excess weight loss


Laparoscopic roux-en-Y gastric bypass


Laparoscopic sleeve gastrectomy


Obstructive sleep apnea






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Conflicts of Interest

The authors declare that they have no competing interests.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As this was a retrospective study, formal national consent is not required.

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Does not apply.


There was no funding source for this study.

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Correspondence to Christel A. L. de Raaff.

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de Raaff, C.A.L., Coblijn, U.K., de Vries, N. et al. Predictive Factors for Insufficient Weight Loss After Bariatric Surgery: Does Obstructive Sleep Apnea Influence Weight Loss?. OBES SURG 26, 1048–1056 (2016).

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  • Bariatric surgery
  • Obstructive sleep apnea
  • Excess weight loss
  • Continuous positive airway pressure