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The following is a summary of “Adverse Cardiovascular Outcomes in Patients With Obstructive Sleep Apnea and Obesity: Metabolic Surgery vs Usual Care,” published in the September 2024 issue of Cardiology by Aminian et al.
No therapy has been shown to reduce the risk of major adverse cardiovascular events (MACE) and death in patients with obstructive sleep apnea (OSA).
Researchers conducted a retrospective study investigating the long-term relationship between metabolic surgery and incident MACE in patients with OSA and obesity.
They identified adult patients with a body mass index of 35 to 70 kg/m2 and moderate-to-severe OSA in a U.S. health system (2004–2018). 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.
The results showed 13,657 patients (7,496 [54.9%] men; mean age 52.0 ± 12.4 years; median body mass index 41.0 kg/m2 [Q1-Q3: 37.6–46.2 kg/m2]), 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 (Q1-Q3: 3.1–8.4 years). The mean between-group difference in body weight at 10 years was 26.6 kg (95% CI: 25.6–27.6 kg) 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 (aHR: 0.58 [95% CI: 0.48–0.71]; P<0.001). The 10-year cumulative incidence of all-cause mortality was 9.1% (95% CI: 5.7%–12.4%) in the metabolic surgery group and 12.5% (95% CI: 11.2%–13.8%) in the nonsurgical group (aHR: 0.63 [95% CI: 0.45–0.89]; P=0.009).
They concluded that 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.
Source: jacc.org/doi/abs/10.1016/j.jacc.2024.06.008
