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Long-term effects of bariatric surgery on obstructive sleep apnea in patients with grade 1 and grade 2 obesity: a sub analysis from GATEWAY study.


Obesity is a well-established risk factor for obstructive sleep apnea (OSA).
Weight loss is associated with OSA severity improvement. In this scenario, bariatric surgery
may be an effective therapy for OSA in obese patients. Previous evidence (most
observational) is limited by short-term analysis in obese grade 3. Here, we hypothesized
that Roux-en-Y gastric bypass (RYGB) surgery has a long-term effect in the OSA severity in
obese grade 1 or 2 patients.


Here, we hypothesized that Roux-en-Y gastric bypass (RYGB) surgery has a long-term effect in the OSA severity in obese grade 1 or 2 patients and we aim to verify this hypothesis


This is a sub analysis of the GATEWAY study (Schiavon et al. Circulation 2018), a randomized controlled clinical trial addressing the impact of RYGB on blood pressure (BP) control in obese patients with body mass index (BMI) <40Kg/m2;
Patients were randomly allocated to receive either RYGB plus optimized clinical treatment (OCT) or OCT treatment alone.
During the ongoing trial, a subsample of patients was invited to perform portable sleep monitoring (Embletta GoldTM) before and after 3 years follow-up. OSA was defined in mild (apnea-hypopnea-index, AHI 5-14.9 events/h), moderate (15-29.9 events/h) and severe (≥30 events/h) forms.
We also evaluated excessive daytime sleepiness (>10 points) by Epworth Sleepiness Scale.
All analyses were performed in a blinded fashion.


A total of 37 patients (n=24 allocated in the RYGB group and n=13 in the OCT
group) were studied in this sub-analysis (83.7% female, mean age: 42±8 years and BMI:
36.7 (35.8-38.5) Kg/m2. Compared to the OTC group, RYGB presented a significant decrease
in BMI (1.7 (-1.9 to 2.7 vs -10.6 (-12.7 to -9.2 ) Kg/m2; p< 0.001), neck circumference (-
1.5 (-2.5 to 2) vs. -7.5 (-10.5 to -4.8 cm; p< 0.001), waist circumference (3 (-3 to 9) vs. -
25 (-30.8 to -20) cm; p< 0.001) and AHI (5 (-4.2 to 12.7) vs. -13.2 (-22.7 to -7) events/h;
p=0.001).The frequency of moderate to severe OSA (AHI (≥15 events/h) at baseline was
62.5% in the RYGB group vs. 46.2% in the OCT group; p=0.175. After the procedure, only
8.3% has moderate OSA (none with severe OSA) in the RYGB group vs 69.3% in the OCT
group; p< 0.001. Consistently, the frequency of excessive daytime sleepiness did not
showed significantly differences at baseline but lower rate in the RYGB group (20.8 vs.
69.2%); p< 0.006 .


In this sub analysis from Gateway study, bariatric surgery is an effective
strategy for decrease long-term OSA severity in patients with obesity grade 1 or 2.


obstructive sleep apnea, body mass index, bariatric surgery


Área Clínica


Sofia Fontanello Furlan Fontanello Furlan, Luciano Ferreira Drager, Franco Chies Martins, Eliana V Santucci, Renato Hideo Nakawaga Santos, Lucas Damiani, Geraldo Lorenzi-Filho, Alexandre B Cavalcante, Carlos A Schiavon