title: Obstructive sleep apnea after weight loss: a clinical trial comparing gastric bypass and intensive lifestyle intervention.
abstract: BACKGROUND
  Few studies have compared the effect of surgical and conservative weight loss strategies on obstructive sleep apnea (OSA). We hypothesized that Roux-en-Y gastric bypass (RYGB) would be more effective than intensive lifestyle intervention (ILI) at reducing the prevalence and severity of OSA (apnea-hypopnea-index [AHI] ≥ 5 events/hour).
  
  
  METHODS
  A total of 133 morbidly obese subjects (93 females) were treated with either a 1-year ILI-program (n = 59) or RYGB (n = 74) and underwent repeated sleep recordings with a portable somnograph (Embletta).
  
  
  RESULTS
  Participants had a mean (SD) age of 44.7(10.8) years, BMI 45.1(5.7) kg/m(2), and AHI 17.1(21.4) events/hour. Eighty-four patients (63%) had OSA. The average weight loss was 8% in the ILI-group and 30% in the RYGB-group (p < 0.001). The mean (95%CI) AHI reduced in both treatment groups, although significantly more in the RYGB-group (AHI change -6.0 [ILI] vs -13.1 [RYGB]), between group difference 7.2 (1.3, 13.0), p = 0.017. Twenty-nine RYGB-patients (66%) had remission of OSA, compared to 16 ILI-patients (40%), p = 0.028. At follow-up, after adjusting for age, gender, and baseline AHI, the RYGB-patients had significantly lower adjusted odds for OSA than the ILI-patients-OR (95% CI) 0.33 (0.14, 0.81), p = 0.015. After further adjustment for BMI change, treatment group difference was no longer statistically significant-OR (95% CI) 1.31 (0.32, 5.35), p = 0.709.
  
  
  CONCLUSIONS
  Our study demonstrates that RYGB was more effective than ILI at reducing the prevalence and severity of OSA. However, our analysis also suggests that weight loss, rather than the surgical procedure per se, explains the beneficial effects.
authors.affiliation: Morbid Obesity Centre, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway. janmagnus.fredheim@siv.no
authors.forename: Jan Magnus
authors.initials: JM
authors.lastname: Fredheim
authors.forename: Jan
authors.initials: J
authors.lastname: Rollheim
authors.forename: Rune
authors.initials: R
authors.lastname: Sandbu
authors.forename: Dag
authors.initials: D
authors.lastname: Hofsø
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
authors.forename: Jo
authors.initials: J
authors.lastname: Røislien
authors.forename: Jøran
authors.initials: J
authors.lastname: Hjelmesæth
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003376:Counseling / Q000379:methods / Q000706:statistics & numerical data; D004038:Diet, Reducing / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods / Q000706:statistics & numerical data*; D015438:Health Behavior; D006266:Health Education / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009664:Norway; D009767:Obesity, Morbid / Q000601:surgery / Q000628:therapy*; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive; D016896:Treatment Outcome; D015431:Weight Loss
keywords: General; bariatric surgery; obstructive sleep apnea; weight loss