Weight-Loss Surgery Cuts Risk of Cardiac Events, Death for Obese People With Obstructive Sleep Apnea

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People who are obese and suffering from obstructive sleep apnea can reduce their 10-year risks of death and major heart complications if they undergo bariatric weight loss surgery, according to a new Cleveland Clinic Study.

Bariatric surgery involves surgical modifications to the stomach or intestines to help individuals lose weight. The study evaluated people who underwent Roux-en-Y gastric bypass and sleeve gastrectomy. Both surgeries reduce the size of the stomach to decrease energy intake.

“The research shows that weight loss achieved with bariatric surgery is significantly associated with a 42% lower risk of major adverse cardiovascular events and 37% lower risk of death in patients with obesity and moderate to severe obstructive sleep apnea,” Dr. Ali Aminian, the primary investigator of the study, said in the press release.

Obstructive sleep apnea is a common breathing disorder affecting the upper airways. It causes people to experience breathing interruptions during sleep, resulting in impaired sleep quality.

Sleep apnea increases people’s risks of heart failure and coronary heart disease. Around 70 percent of people with obstructive sleep apnea are obese.

“[Before the study], no therapy had been shown to reduce the risk of major adverse cardiovascular events and death in patients with sleep apnea,” said Dr. Steven Niessen, senior author of the study.

Study Findings

The authors evaluated electronic health data of 13,657 obese adults diagnosed with moderate to severe obstructive sleep apnea between 2004 and 2018. Patients who underwent bariatric surgery were compared against those who did not, and tracked for up to 10 years.

The authors found that, compared to obese people with obstructive sleep apnea who did not undergo surgery, those who underwent surgery had a 12 percent lower risk of suffering from cardiovascular events and a 4 percent lower risk of dying within 10 years.

People who did surgery lost more than 33 kilograms or around 73 pounds, which is five times the weight loss of the non-surgical group.

The authors found that nonsurgical patients who lost less than 10 percent of their body weight had a higher incidence of cardiovascular events.

However, regardless of whether they had undergone surgery or not, patients who lost more than 10 percent of their body weight had no statistically significant difference in their incidence of cardiovascular events.

“In select patients, bariatric surgery is a lifesaving treatment,” Dr. Aminian said. “The study suggests the presence of a dose-dependent response between the amount of weight loss and cardiovascular benefits in patients with obstructive sleep apnea, the greater the weight loss, the lower the risk of heart complications.”

Procedure Safety

Bariatric surgery is intended for people who have obesity and need to lose weight but have not been able to do so through other means.

It can help people lose weight and improve health problems associated with obesity. However, it also has health risks.

Short-term complications of bariatric surgery include excessive bleeding, blood clots, infections, reactions to anesthesia, breathing problems, leaks in the gastrointestinal system, and rarely death.

Long-term risks of bariatric surgery vary based on the type of surgery.

Roux-en-Y gastric bypass is a weight loss surgery that involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine. This surgery bypasses most of the stomach and the first section of the small intestine.

Long-term risks of Roux-en-Y gastric bypass include bowel obstruction, rapid stomach emptying (which can lead to diarrhea), nausea, gall stones, hernias, low blood sugar, malnutrition, hole formation in the stomach, ulcers, and vomiting.

In sleeve gastrectomy, about 80 percent of the stomach is removed, leaving a tube-shaped stomach around the shape and size of a banana.

Long-term risks of sleeve gastrectomy include gastrointestinal obstruction, hernias, severe acid reflux, low blood sugar, malnutrition, and vomiting.