BARIATRIC surgery lowers the risk for major adverse cardiovascular (CV) events and mortality in patients with obesity and obstructive sleep apnoea, according to a new study. Nearly 1 billion people in the world have obstructive sleep apnoea, and in almost 75% of people, obesity is an underlying cause. Sleep apnoea is a major risk factor for CV disease, such as heart failure, cardiac arrhythmias, and heart attack, which is why a team of researchers investigated whether this risk was improved with weight loss.
Ali Aminian, Cleveland Clinic Lerner College of Medicine, Ohio, USA, and colleagues, conducted a retrospective single-centre study including 16,657 patients with a BMI between 35–70 kg/m2 and moderate-to-severe obstructive sleep apnoea, which was defined as an apnoea-hypopnea index of 15 or more events per hour. In total, 970 participants had bariatric surgery, with an average weight loss of 25% of body weight, compared to less than 5% in the control group. Primary outcome of the study was extended major adverse CV events, including cerebrovascular events, atrial fibrillation, coronary artery events, heart failure, and mortality.
Cumulative incidence of major adverse CV events at 10 years was 27.3% in the surgery, compared with 34.1% in the control group (adjusted absolute risk difference: 4.2%; 95% confidence interval: 2–11.5; adjusted hazard ratio: 0.63; 95% confidence interval: 0.52–0.77; p <0.001). Furthermore, all-cause mortality rates were 9.1% in those who had surgery, compared with 12.5% in the control group.
While the team expected a risk reduction, they stated its magnitude was surprising, but comparable to risk reduction in other populations, such as patients with fatty liver disease or diabetes. “It seems like the weight loss that comes with bariatric surgery can protect these patients’ hearts from developing adverse consequences,” stated Aminian.
The team concluded that sleep apnoea needs to be considered when counselling patients with obesity, and that bariatric surgery is a safe and effective tool to reduce risk of CV events and mortality.