Weight loss through bariatric surgery reduced the risk of major adverse cardiovascular events (MACE) by 42% and all-cause mortality by 37% in obese patients with moderate-to-severe obstructive sleep apnea (OSA) compared to those who did not undergo the surgery, according to the MOSAIC study.
Dr. Ali Aminian from the Cleveland Clinic emphasized the study’s significance, stating that it addresses the primary cause of OSA—obesity and fat accumulation. The results were published online on June 21 in the Journal of the American College of Cardiology.
OSA affects nearly 1 billion people globally, yet clinicians have lacked solid data to guide treatment decisions, Aminian noted. While positive airway pressure (PAP) treatments alleviate symptoms, they have not shown broader health benefits such as reducing MACE in clinical trials. Furthermore, there are no approved pharmacologic treatments for OSA.
Aminian and his team conducted a retrospective cohort study involving adults with obesity and moderate-to-severe OSA seen at the Cleveland Clinic Health System from 2004 to 2018. The study included 13,657 adults with a BMI of 35-70 kg/m², of whom 970 underwent bariatric surgery and 12,687 received other treatments. Follow-up continued until September 2022.
To reduce confounding factors, researchers used overlap weighting and outcome regression, mimicking attributes of randomized clinical trials. They found the 10-year cumulative incidence of MACE was 27% in the bariatric surgery group and 35.6% in the nonsurgical group (adjusted hazard ratio [HR], 0.58; P < .001). All-cause mortality at 10 years was 9.1% for the surgery group and 12.5% for the nonsurgical group (adjusted HR, 0.63; P = .009).
Aminian pointed out that individuals with obesity and apnea often require more weight loss than can typically be achieved through lifestyle changes alone. Effective methods like bariatric surgery or new obesity medications should be considered to significantly improve outcomes.
The study’s findings could promote the use of these approaches and enhance insurance coverage, Aminian added. However, the study’s reliance on data from a single source, the Cleveland Clinic Health System, and potential coding errors in electronic health records are noted limitations.
“Surprising” Findings
The MOSAIC findings received commendation from external researchers. Dr. David Kuhlmann, medical director of sleep medicine at Bothwell Regional Health Center, highlighted the substantial decrease in heart failure incidence, noting a 70% lower risk in the bariatric surgery group.
Kuhlmann suggested further research to determine if weight loss medications could provide similar benefits as surgery, offering patients another non-surgical treatment option for managing OSA.
Additionally, two studies presented at the American Diabetes Association 84th Scientific Sessions reported reduced sleep apnea in patients with OSA and obesity using the diabetes and weight loss drug tirzepatide.
Dr. Vsevolod Polotsky of George Washington University School of Medicine & Health Sciences praised the approach used by Aminian and his colleagues at the Cleveland Clinic.
