# Obstructive Sleep Apnea Following Bariatric Surgery: 20 Year Outcomes From the Swedish Obese Subjects Study

## TL;DR

Bariatric surgery significantly reduces obstructive sleep apnea over 20 years compared to usual care.

## Contribution

This study shows long-term OSA remission and prevention benefits of bariatric surgery over two decades.

## Key findings

- Bariatric surgery reduced OSA prevalence by 32.1 percentage points in patients with baseline OSA.
- Surgery also reduced new-onset OSA by 5.8 percentage points in those without initial OSA.
- Benefits of surgery were sustained over 20 years compared to usual obesity care.

## Abstract

Bariatric surgery has been suggested to improve obstructive sleep apnea (OSA) in short‐term studies, but long‐term evidence is limited. We evaluated remission and new onset of OSA over 20 years in participants from the Swedish Obese Subjects (SOS) study, comparing bariatric surgery with usual obesity care.

The SOS study is a nonrandomized, controlled intervention study including 4047 individuals who received bariatric surgery (n = 2010) or usual obesity care (n = 2037). OSA status was assessed via questionnaires at baseline and at 1, 2, 3, 4, 6, 8, 10, 15, and 20 years. We examined remission and new onset of OSA among participants with or without the condition at baseline, comparing surgery to usual care.

On average over 20 years, bariatric surgery was associated with a 32.1 percentage points lower prevalence of OSA in participants with baseline OSA (95% CI: −36.9 to −27.2; p < 0.001) compared to usual care. Among those without baseline OSA, surgery patients had a 5.8 percentage points lower prevalence of new‐onset OSA (95% CI: −7.1 to −4.6; p < 0.001).

Bariatric surgery was associated with durable OSA benefits, including higher remission and lower long‐term new onset of OSA compared to usual obesity care.

ClinicalTrials.gov identifier: NCT01479452

What is already known?
○Several short‐ and mid‐term studies, including our own previous findings, indicate a strong association between bariatric surgery and resolution of obstructive sleep apnea (OSA) or improvement of apnea/hypopnea index, but long‐term studies are lacking.

What does this study add?
○This study extends existing knowledge by suggesting that the association between bariatric surgery and remission of OSA is maintained over an exceptionally long follow‐up period of 20 years, compared to a matched control group.○Moreover, it indicates that bariatric surgery is associated with a reduced long‐term incidence of de novo OSA among individuals without baseline OSA, compared to usual obesity care.

How might these results change the direction of research or the focus of clinical practice?
○These findings point toward sustained benefits of bariatric surgery in both the resolution of existing OSA and the prevention of new cases.○This provides support for broader consideration of bariatric surgery as both a therapeutic and preventive strategy for OSA in individuals with obesity.

What is already known?
○Several short‐ and mid‐term studies, including our own previous findings, indicate a strong association between bariatric surgery and resolution of obstructive sleep apnea (OSA) or improvement of apnea/hypopnea index, but long‐term studies are lacking.

Several short‐ and mid‐term studies, including our own previous findings, indicate a strong association between bariatric surgery and resolution of obstructive sleep apnea (OSA) or improvement of apnea/hypopnea index, but long‐term studies are lacking.

What does this study add?
○This study extends existing knowledge by suggesting that the association between bariatric surgery and remission of OSA is maintained over an exceptionally long follow‐up period of 20 years, compared to a matched control group.○Moreover, it indicates that bariatric surgery is associated with a reduced long‐term incidence of de novo OSA among individuals without baseline OSA, compared to usual obesity care.

This study extends existing knowledge by suggesting that the association between bariatric surgery and remission of OSA is maintained over an exceptionally long follow‐up period of 20 years, compared to a matched control group.

Moreover, it indicates that bariatric surgery is associated with a reduced long‐term incidence of de novo OSA among individuals without baseline OSA, compared to usual obesity care.

How might these results change the direction of research or the focus of clinical practice?
○These findings point toward sustained benefits of bariatric surgery in both the resolution of existing OSA and the prevention of new cases.○This provides support for broader consideration of bariatric surgery as both a therapeutic and preventive strategy for OSA in individuals with obesity.

These findings point toward sustained benefits of bariatric surgery in both the resolution of existing OSA and the prevention of new cases.

This provides support for broader consideration of bariatric surgery as both a therapeutic and preventive strategy for OSA in individuals with obesity.