The Beneficial Effect of Weight Reduction on Adverse Cardiovascular Outcomes Following Bariatric Surgery Is Attenuated in Patients With Obstructive Sleep Apnea

Authors

• Ahmed Dalmar, Advocate Aurora Health - Milwaukee
• Maharaj Singh, Marquette UniversityFollow
• Bennet Pandey, Advocate Health - Midwest
• Christopher Stoming, Advocate Health - Midwest
• Zoe Heis, Advocate Aurora Health - Milwaukee
• Khawaja Afzal Ammar, Advocate Health - Midwest
• M. Fuad Jan, Aurora Health Care
• Indrajit Choudhuri, Aurora Health Care
• Thomas Y. Chua, Aurora Sinai Medical Center - Milwaukee
• Jasbir Sra, Aurora Advocate Healthcare
• A. Jamil Tajik, Aurora St. Luke’s Medical School
• Arshad Jahangir, Aurora Health Care

Document Type

Article

Publication Date

5-2018

Publisher

Oxford University Press

Source Publication

SLEEP

Source ISSN

0161-8105

Abstract

Weight loss after bariatric surgery is associated with reduction in adverse cardiovascular outcomes; however, the impact of obstructive sleep apnea (OSA) on reduction of cardiovascular outcomes after bariatric surgery in morbidly obese patients is not known. We retrospectively assessed differences in cardiovascular events after laparoscopic adjustable gastric banding (LAGB)–induced weight loss in patients with and without OSA before and after propensity score matching for age, sex, body mass index (BMI), and major comorbidities between the two groups and determined predictors of poor outcomes. OSA was present in 222 out of 830 patients (27 per cent) who underwent LAGB between 2001 and 2011. Despite a similar reduction in BMI (20.0 and 20.8 per cent), a significantly higher percentage of cardiovascular events were observed in patients with than without OSA (35.6 vs 6.9 per cent; p < 0.001) at 3 years (mean follow-up 6.0 ± 3.2; range: 0.5 to 13 years). The differences in the cumulative endpoint of new onset stroke, heart failure, myocardial infarction, venous thrombosis, and pulmonary embolism between the OSA and non-OSA groups were maintained after propensity matching. Patients with OSA treated with continuous positive airway pressure (CPAP) during sleep [n = 66] had lower cardiovascular event rates at 30 months compared with those not treated (p < 0.041). OSA (hazard ratio: 6.92, 95% CI: 3.39–14.13, p < 0.001) remained an independent predictor of cardiovascular events after multivariate analysis. Thus, patients with OSA, despite a similar initial weight loss after LAGB, had a higher incidence of cardiovascular events compared with a propensity-matched group without OSA. Treatment with CPAP appears to reduce such events.

Comments

Accepted version. Sleep, Vol. 41, No. 5 (May 2018). DOI. This article is © Sleep Research Society. Used with permission.

Maharaj Singh was affiliated with Aurora Health Care at the time of publication.

Recommended Citation

Dalmar, Ahmed; Singh, Maharaj; Pandey, Bennet; Stoming, Christopher; Heis, Zoe; Ammar, Khawaja Afzal; Jan, M. Fuad; Choudhuri, Indrajit; Chua, Thomas Y.; Sra, Jasbir; Tajik, A. Jamil; and Jahangir, Arshad, "The Beneficial Effect of Weight Reduction on Adverse Cardiovascular Outcomes Following Bariatric Surgery Is Attenuated in Patients With Obstructive Sleep Apnea" (2018). College of Nursing Faculty Research and Publications. 1237.
https://epublications.marquette.edu/nursing_fac/1237