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Treatment Discontinuation Following Bariatric Surgery in Obstructive Sleep Apnea: a Controlled Cohort Study

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Abstract

Background

Uncontrolled studies looking at the discontinuation of obstructive sleep apnea (OSA) treatment after bariatric surgery (BS) have suggested that surgery improves OSA. However, this discontinuation of OSA treatment by BS patients has never been compared to a matched population without BS. The objectives of this study are to evaluate whether BS increases OSA treatment discontinuation compared to that in matched patients without BS and to identify predictive factors of OSA treatment discontinuation in BS patients. The study took place in an ambulatory, tertiary hospital.

Methods

We included 61 OSA patients who underwent BS in a retrospective controlled cohort study. The computerized matching procedure included age, sex, body mass index, year of starting OSA treatment, treatment type, and duration selected 59 controls matched to 28 patients with BS. The main outcome was OSA treatment discontinuation within 2 years after BS.

Results

Patients with BS stopped OSA treatment more often than controls, usually between 6 months and 1 year after BS: hazards ratio (HR (95 %, CI)) 15.93 (3.29, 77.00). Before 6 months or beyond 1 year after BS, treatment discontinuation was not different between BS patients and controls. In univariate analyses, female gender, absence of co-morbidities, greater weight loss, and lower baseline OSA severity were associated with stopping OSA treatment after BS. No factor remained independently associated in multivariate analysis.

Conclusions

Apneic patients having BS stop OSA treatment more than matched controls. Treatment discontinuation may be attributed to recovery or to abandonment. The effect of BS on OSA may have been overestimated in uncontrolled BS studies that ignored basal OSA treatment discontinuation in routine clinical practice.

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Acknowledgments

We thank Nathalie Arnol who performed statistical analyses, Matthieu Lesgoirres who was involved in collecting retrospective data and Dr. Alison Foote (Grenoble Clinical Research Center) for critically reading and editing the manuscript with respect to English language.

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Authors and Affiliations

  1. Pole DIGIDUNE, Endocrinology Department, Grenoble University Hospital, Grenoble, France

    Claire Agosta & Anne-Laure Borel

  2. “ICàdom”, Agiràdom, Meylan, France

    Jean-Christian Borel & Nelly Wion

  3. HP2 laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France

    Jean-Christian Borel, Jean-Louis Pépin & Anne-Laure Borel

  4. Pole DIGIDUNE, Digestive Surgery Department, Grenoble University Hospital, Grenoble, France

    Fabian Reche & Catherine Arvieux

  5. Anaesthesiology and Intensive Care, Anaesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, INSERM U1046, Montpellier 1 University, Montpellier University Hospital, Montpellier, 34295, France

    Samir Jaber

  6. Pulmonary Disorders and Respiratory Sleep Disorders Unit, Polyclinic Saint-Privat, 34760, Boujan sur Libron, France

    Dany Jaffuel

  7. Pole Thorax et vaisseaux, Clinique Physiologie, Sommeil et Exercice, Grenoble University Hospital, Grenoble, France

    Jean-Louis Pépin

Authors
  1. Claire Agosta
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  2. Jean-Christian Borel
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  4. Catherine Arvieux
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  5. Nelly Wion
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  8. Jean-Louis Pépin
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  9. Anne-Laure Borel
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Corresponding author

Correspondence to Anne-Laure Borel.

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Grants

“Fonds Agir pour les maladies chroniques”

Funding

The present study was supported by “Fond Agir pour les maladies chroniques.”

Disclosure Summary

CA: has no relevant conflict of interest to disclose

JCB: is employed by “Agiràdom”, a non-profit home care provider

FR: has nothing to declare regarding this study.

CA: has nothing to declare regarding this study.

NW: has nothing to declare regarding this study.

SJ: has nothing to declare regarding this study.

DJ: has nothing to declare regarding this study.

JLP: has nothing to declare regarding this study.

ALB: received grant support from “Agiràdom”, a non-profit home care provider in 2009, 2011, 2012, 2013 and 2014

According to French law, this database study using data from routine clinical practice records, did not require informed consent. The study was approved by the institutional ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its amendments or comparable ethical standards.

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Agosta, C., Borel, JC., Reche, F. et al. Treatment Discontinuation Following Bariatric Surgery in Obstructive Sleep Apnea: a Controlled Cohort Study. OBES SURG 26, 2082–2088 (2016). https://doi.org/10.1007/s11695-016-2048-9

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  • DOI: https://doi.org/10.1007/s11695-016-2048-9

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