Volume 200 - Issue 3
Surgery for adult obstructive sleep apnoea
Authors: Stuart G MacKay and Edward M Weaver
Med J Aust 2014; 200 (3): 145-146. || doi: 10.5694/mja13.00051
Published online: 17 February 2014
Published online: 17 February 2014
The debate about bariatric surgery as a cost-effective and holistic surgical option for OSA continues
In reply: We agree that bariatric surgery is an important treatment for obesity-related obstructive sleep apnoea (OSA) but disagree on the body mass index (BMI) criterion and on Wong’s interpretation of the literature.
Published guidelines recommend bariatric surgery for BMI more than 40 kg/m2 or for BMI more than 35 kg/m2 with obesity-related comorbidities.1,2
We disagree that bariatric surgery is the “most evidence-based surgical option for OSA”. The meta-analyses cited by Wong include small Level IV studies on OSA and the apnoea–hypopnoea index (AHI), but no data on OSA-related clinical outcomes (eg, quality of life, sleepiness, daytime function, cardiovascular disease, or mortality) independent of obesity.3,4 One meta-analysis (four studies; 92 patients) reported a mean AHI decrease of 34 events per hour without reporting final AHI.3 The larger meta-analysis (12 studies; 342 patients) reported a mean AHI decrease of 38 events per hour, from 55 to 16, leaving residual moderate OSA, and the authors to caution “that patients should not expect a cure” for OSA.4 A more recent Australian trial showed an AHI decrease from 65 to 40 events per hour, leaving residual severe OSA after bariatric surgery in obese OSA patients.5
Competing interests
No relevant disclosures.
References
- National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: NHMRC, 2013. http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n57_obesity_guidelines_130531.pdf (accessed Nov 2013).
- National Institutes of Health National Heart, Lung, and Blood Institute, North American Association for the Study of Obesity. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. (NIH Publication No. 00-4084.) http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_b.pdf (accessed Nov 2013).
- Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292: 1724-1737. i1142879
- Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med 2009; 122: 535-542. i1142881
- Dixon JB, Schachter LM, O’Brien PE, et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA 2012; 308: 1142-1149. i1142885