Interest in bariatric surgery among obese patients with obstructive sleep apnea

Abstract

Background: Standard obstructive sleep apnea (OSA) therapies are poorly tolerated. Bariatric surgery is a potential alternative but the level of interest in this intervention among OSA patients is unknown.

Objectives: Determine the proportion of OSA patients who would be interested in bariatric surgery.

Setting: Sleep clinics, United States.

Methods: Consecutive adult patients with untreated severe OSA and a body mass index of 35-45 kg/m(2) were approached. Patients at low perioperative risk and no urgent indication for OSA treatment were invited to a separate informational visit about bariatric surgery as primary treatment for OSA.

Results: Of 767 eligible patients, 230 (30.0%) were not at low perioperative risk, 49 (6.4%) had drowsy driving, and 16 (2.1%) had no insurance coverage for bariatric surgery. Of the remaining 482 patients, over one third (35.5%) were interested in bariatric surgery. Surgical interest was 47.2% in women versus 27.6% in men (P<0.01) and 67.3% in diabetics versus 31.0% in nondiabetics (P<0.01). In multivariable adjusted models, female gender (odds ratio 1.89, 95% CI [1.10-3.25]) and diabetes (odds ratio 3.97, 95% CI [1.97-8.01]) remained highly predictive of bariatric surgery interest.

Conclusions: Nearly two thirds of obese patients with severe OSA are good candidates for bariatric surgery. Among candidates, over one third are interested in this treatment. Interest rates are highest among women and diabetics, indicating that metabolic improvements continue to be a major driver of surgery even in patients with severe OSA. Given patient interest, the role of bariatric surgery should be routinely discussed with obese OSA patients.

Keywords: Bariatric surgery; Diabetes; Obesity; Obstructive sleep apnea; Perioperative risk.

Conflict of interest statement

Summary of Conflicts of Interest:

None of the authors report any relevant conflicts of interest.

Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Assessment of Bariatric Surgical Candidacy and Surgical Interest Classification of obstructive sleep apnea patients by eligibility and interest in bariatric surgery. Some patients who were not candidates for bariatric surgery were in multiple categories (e.g. not at low peri-operative risk and also had drowsy driving).