Obstructive Sleep Apnea in Adults.

Abstract

To the Editor: In their review article, Veasey and Rosen (April 11 issue)1 recommend weight loss for obese patients with obstructive sleep apnea, since obesity is the main risk factor. However, the authors scarcely mention bariatric surgery. We found this surprising, since obesity is notoriously difficult to treat and is mostly refractory to nonsurgical interventions, whereas bariatric surgery is often associated with long-term, substantial weight loss.2 The authors state that no significant reduction in the score on the Apnea–Hypopnea Index (AHI) was found when bariatric surgery was compared with nonsurgical interventions. The cited reference is a randomized trial that involved only 60 patients.3 In addition, participants underwent gastric banding, a procedure that is outdated, since other bariatric procedures have proved to be more efficacious.4,5 A meta-analysis of nonrandomized studies showed an 85.7% remission rate of obstructive sleep apnea after bariatric surgery.4 Given the current efficacy and safety of bariatric surgery, we think that this treatment method deserves more attention as an option for obese patients with obstructive sleep apnea. However, larger, adequately powered, randomized trials that examine the effect of bariatric surgery on obstructive sleep apnea are needed.