Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity

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/m(2)) and control group (40.1 +/- 4.6 kg/m(2)) changed -9.7 5 kg/m(2) and 0 +/- 3 kg/m(2), 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 < .001). Persistence of snoring (21.6 vs 65.5%, adjusted OR 0.14, 95% CI 010-0.19) 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.