Background:
No therapy has been shown to reduce the risk of major adverse cardiovascular events (MACE) and death in patients with obstructive sleep apnea (OSA).
Objectives:
To investigate the long-term relationship between metabolic surgery and incident MACE in patients with OSA and obesity.
Methods:
Adult patients with BMI 35-70 kg/m2 and moderate-to-severe OSA at a US health system (2004-2018) were identified. Baseline characteristics of patients who underwent metabolic surgery were balanced with a nonsurgical control group using overlap weighting methods. Multivariable Cox regression analysis estimated time-to-incident MACE. Follow-up ended in September 2022.
Results:
13,657 patients (7496 [54.9%] men; mean age, 52.0 years [SD 12.4]; median BMI, 41.0 [IQR, 37.6-46.2]), including 970 patients in the metabolic surgery group and 12,687 patients in the nonsurgical group, with a median follow-up of 5.3 years (IQR, 3.1-8.4 years) were analyzed. The mean between-group difference in body weight at 10 years was 26.6 kg (95% CI, 25.6-27.6) or 19.3% (95% CI, 18.6%-19.9%). The 10-year cumulative incidence of MACE was 27.0% (95% CI, 21.6%-32.0%) in the metabolic surgery group and 35.6% (95% CI, 33.8%-37.4%) in the nonsurgical group (adjusted HR, 0.58 [95% CI, 0.48-0.71], P
Conclusions:
Among patients with moderate-to-severe OSA and obesity, metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident MACE and death.
Keywords:
Metabolic surgery; bariatric surgery; cardiovascular; obesity; sleep apnea; weight loss.