Clinical research studyEffects of Surgical Weight Loss on Measures of Obstructive Sleep Apnea: A Meta-Analysis
Section snippets
Search Strategy
With the assistance of a reference librarian, we performed an online search of the MEDLINE and EMBASE databases to identify potentially relevant studies. Search terms included obstructive sleep apnea, obstructive sleep apnoea, sleep-disordered breathing, bariatric surgery, surgical weight loss, gastric bypass, and obesity. All databases were searched from inception to March 17, 2008. The search was limited to case series reporting data on patients who underwent a clinical assessment and
Results
A total of 2309 references were retrieved by the search. The flow of studies is shown in Figure 1. Review of the titles allowed for exclusion of 2249 publications. We reviewed the abstracts for 60 publications. Of the abstracts reviewed, 22 articles were reviewed. After excluding duplicate studies and studies that did not meet the inclusion criteria, we identified 12 studies representing 342 patients for inclusion.
The characteristics of the included studies are shown in Table 1. Most studies
Discussion
The results of our meta-analysis corroborate previously reported improvements in AHI after bariatric surgery. The overall effect size of the pooled, weighted data shows a reduction of 38.2 events per hour in the combined study results, a combined reduction in AHI of 71%. This is a substantial improvement for obese patients with sleep apnea. However, residual disease is seen in the majority of patients (62%) after bariatric surgery with a mean residual AHI of more than 15 events per hour. A
Conclusions
Given the limitations of the pooled studies and the finding that the mean follow-up BMIs of patients in both aggregate and individual patient data analyses were still in the obese range, additional larger, prospective studies are needed to better define patients for whom follow-up polysomnograms are warranted. The high prevalence of clinically unsuspected OSA identified in patients before bariatric surgery has led some bariatric surgical centers to universally screen all patients with baseline
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Funding: None.
Conflict of Interest: All authors are employees of the Department of Defense. Expressed opinions represent those of the authors and do not represent those of the Department of Defense.
Authorship: All authors had access to the data and played a role in writing this manuscript.