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This surgery reduces stroke risk for those with sleep apnea



According to a new study, bariatric surgery, also called weight-loss or metabolic surgery, was associated with a 42 per cent lower risk of major adverse cardiovascular events (MACE), including stroke, and atrial fibrillation in patients with moderate to severe obstructive sleep apnea (OSA).

OSA is a dangerous sleep disorder that effects close to 1 billion adults worldwide and about 70 per cent of those adults also have obesity. 

Obesity may cause excess fat to deposit around the upper airway, which can compress the upper airways and interfere with breathing during sleep. 

The standard treatment is with continuous positive airway pressure (CPAP), however, the therapy only addresses symptoms and is not curative, furthermore, it does not reduce the risk of MACE or death, which has a high incidence among patients with OSA.

The study lead author, Ali Aminian, says: “No other therapy has been shown to reduce the risk of dying or developing heart attack or heart failure in patients with obesity and obstructive sleep apnea. 

“Bariatric surgery is a very powerful tool that can help patients with sleep apnea live longer and healthier lives.”

In the cohort study of 13,657 Cleveland Clinic patients with a diagnosis of obesity and moderate to severe OSA, 970 patients had gastric bypass or sleeve gastrectomy while 12,687 matched patients received CPAP or usual non-surgical care between 2004 and 2018. Patients were followed until September 2022 for MACE, a composite of all-cause death or cardiovascular disease.

After 10 years, MACE occurred in 27 per cent of patients in the bariatric surgery group compared to 35.6 per cent in the nonsurgical group. All-cause mortality was also 37 per cent less for bariatric surgery patients (9.1 per cent vs. 12.5 per cent) who maintained about a 25 per cent weight loss compared to the under 5 per cent weight loss in the nonsurgical group.

Teresa LaMasters, MD, President, ASMBS and a bariatric surgeon and board-certified obesity medicine physician, who was not involved in the study, says: “Bariatric surgery not only improves the symptoms of obstructive sleep apnea in patients with obesity, but largely reduces or eliminates the cardiovascular complications that can often occur alongside it compared to routine care.

“Patients and their doctors should strongly consider this option and determine if it’s right for them. Further studies may explore the threshold of weight loss required for optimal clinical impact on outcomes.”