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SLEEP - Article Abstract

Volume :	30
Issue :	06
Pages :	703-710

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Two Year Reduction In Sleep Apnea Symptoms and Associated Diabetes Incidence After Weight Loss In Severe Obesity

Ronald R. Grunstein, MD, PhD^1,3; Kaj Stenlöf, MD, PhD²; Jan A. Hedner, MD, PhD^1,3; Markku Peltonen, PhD⁴; Kristjan Karason, MD, PhD⁵; Lars Sjöström, MD, PhD²

Departments of Pulmonary and Sleep Medicine,¹ Medicine,² and Cardiology,⁵ Sahlgrenska University Hospital, Göteborg, Sweden; ³NHMRC Centre for Respiratory and Sleep Medicine, Woolcock Institute of Medical Research, Royal Prince Alfred Hospital and University of Sydney, Camperdown, Sydney, Australia; ⁴Diabetes Unit, National Public Health Institute, Helsinki, Finland

Study Objectives:

To evaluate the effect of bariatric surgery on sleep apnea symptoms and obesity-associated morbidity in patients with severe obesity.

Design:

Prospective study.

Setting:

University hospitals and community centers in Sweden.

Intervention:

We investigated the influence of weight loss surgery (n="1729)" on sleep apnea symptoms and obesity-related morbidity using a conservatively treated group (n="1748)" as a control.

Measurements and Results:

Baseline BMI in surgical group (42.2±4.4 kg/m2) and control group (40.1±4.6 kg/m2) changed —9.7±5 kg/m2 and 0±3 kg/m2, respectively, at 2-year follow-up. In the surgery group, there was a marked improvement in all obstructive sleep apnea (OSA) symptoms compared with the control group (P <0.001). Persistence of snoring (21.6 vs 65.5%, adjusted OR 0.14, 95% CI 0.10-0.19) and apnea (27.9 vs 71.3%, adjusted OR 0.16, 95% CI 0.10-0.23) were much less in the surgery group compared with controls. Compared with subjects with no observed apnea at follow-up (n="2453)," subjects who continued to have or developed observed apnea (n="404)" had a higher incidence of diabetes (adjusted OR 2.03, 95% CI 1.19-3.47) and hypertriglyceridemia (adjusted OR 1.86, 95% CI 1.07-3.25) but not hypertension (adjusted OR 1.09, 95% CI 0.65-1.83) or hypercholesterolemia (adjusted OR 0.91, 95% CI 0.53-1.58).

Conclusion:

Bariatric surgery results in a marked improvement in sleep apnea symptoms at 2 years. Despite adjustment for weight change and baseline central obesity, subjects reporting loss of OSA symptoms had a lower 2-year incidence of diabetes and hypertriglyceridemia. Improvement in OSA in patients losing weight may provide health benefits in addition to weight loss alone.
Citation: Grunstein RR; Stenlöf KS; Hedner JA et al. Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. SLEEP 2007;30(6):703-710