Ali Aminian, M.D., director of Cleveland Clinic’s Bariatric & Metabolic Institute and primary investigator of the MOSAIC study, highlighted that weight loss achieved through bariatric surgery significantly correlates with a 42% reduction in major adverse cardiovascular events and a 37% decrease in mortality risk among patients suffering from obesity and moderate to severe obstructive sleep apnea. This underscores the potential life-saving benefits of surgical intervention for this high-risk population.
Research published in The Lancet Respiratory Medicine indicates that nearly 1 billion adults worldwide are affected by obstructive sleep apnea, with obesity being a primary risk factor. The Obesity Medicine Association reports that approximately 70% of adults diagnosed with obstructive sleep apnea are also obese. This combination exacerbates metabolic disruptions and contributes to heightened risks of severe health conditions, including heart attacks and heart failure.
The MOSAIC (Metabolic surgery for OSA and Incident Cardiovascular disease) study, led by Cleveland Clinic, represents the first comprehensive analysis of long-term cardiovascular outcomes following bariatric surgery in patients with obstructive sleep apnea and obesity. From 2004 to 2018, the observational study involved 13,657 adult patients with a body mass index ranging from 35 to 70 and diagnosed with moderate to severe obstructive sleep apnea through sleep study tests.
Among the participants, 970 underwent bariatric surgery, while 12,687 served as a nonsurgical control group, balanced using overlap weighting methods. Follow-up continued until September 2022, revealing compelling findings about the benefits of surgical weight loss interventions.
Over ten years, the cumulative incidence of major adverse cardiovascular events was markedly lower among those who underwent bariatric surgery (27%) compared to the nonsurgical group (35.6%). This encompassed coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and all-cause mortality. Similarly, the cumulative incidence of all-cause mortality at ten years was 9.1% in the bariatric surgery cohort versus 12.5% in the nonsurgical group, indicating a significant survival advantage associated with surgical intervention.
Steven Nissen, M.D., Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic and senior author of the study, emphasised the lack of approved drug therapies specifically targeting obstructive sleep apnea. Before the MOSAIC study, no intervention had demonstrated efficacy in reducing major adverse cardiovascular events or mortality rates in patients with this condition.
Patients who underwent bariatric surgery experienced substantial weight loss, averaging 33.2 kg over the 10-year study period, in contrast to the nonsurgical group, which lost an average of 6.64 kg. Remarkably, those who underwent surgery maintained a 25% weight loss even after a decade post-procedure, underscoring the long-term efficacy of bariatric interventions in managing obesity.
Nancy Foldvary-Schaefer, D.O., director of Cleveland Clinic’s Sleep Disorders Center, noted that current guidelines for managing obstructive sleep apnea stress the importance of weight loss and lifestyle modifications. The findings from the MOSAIC study reinforce these guidelines but also highlight the necessity for more effective and durable interventions, such as bariatric surgery, to enhance cardiovascular outcomes and survival in affected patients.
Dr. Aminian further emphasised that bariatric surgery can be a life-saving treatment for select patients, suggesting a dose-dependent relationship between weight loss and cardiovascular benefits in those with obstructive sleep apnea. More significant weight loss correlated with lower risks of heart complications, illustrating the potential for substantial health improvements through surgical intervention.
Looking ahead, with the emergence of new obesity medications capable of achieving average weight loss rates of 15-20%, similar cardiovascular benefits may be achievable through medical therapies. This possibility underscores ongoing advancements in obesity management and the potential to broaden treatment options for patients with complex health conditions like obstructive sleep apnea and obesity.
More information: Ali Aminian et al, Adverse Cardiovascular Outcomes in Patients with Obstructive Sleep Apnea and Obesity: Metabolic Surgery versus Usual Care, Journal of the American College of Cardiology. DOI: 10.1016/j.jacc.2024.06.008
Journal information: Journal of the American College of Cardiology Provided by Cleveland Clinic
