Impact of Bariatric Surgery on Control of Obstructive Sleep Apnea and Hypopnea Syndrome: Comparison Between Gastric Bypass and Sleeve Gastrectomy

Impact of Bariatric Surgery on Control of Obstructive Sleep Apnea and Hypopnea Syndrome: Comparison Between Gastric Bypass and Sleeve Gastrectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Impact of Bariatric Surgery on Control of Obstructive Sleep Apnea and Hypopnea Syndrome: Comparison Between Gastric Bypass and Sleeve Gastrectomy Eduardo Sávio Nascimento Godoy, Flávio Kreimer, Thiago Freire Pinto Bezerra, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7011881/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Bariatric surgery is well-established treatment for grade 2 and 3 obesity refractory to clinical measures. Obstructive Sleep and Apnea Hypopnea Syndrome is among the comorbidities controlled by bariatric surgery. Patients undergoing bariatric surgery show global improvement in respiratory function. However, there is no formal indication of a specific surgical technique for better control of apnea. Objective : To evaluate the evolution of apnea/hypopnea indices, associated with weight loss, in individuals undergoing two bariatric surgery techniques: Sleeve Gastrectomy and Gastric Bypass. Methods : Prospective cohort carried out at Hospital Santa Joana Recife – Pernambuco - Brazil, including obese patients with Sleep Apnea and Hypopnea Syndrome undergoing bariatric surgery, for pre- and postoperative evaluation through polysomnography. Body mass and apnea/hypopnea indexes were measured pre- and postoperatively. Results : 30 participants were selected, 18 of whom underwent Sleeve Gastrectomy and 12 underwent Gastric Bypass, 73.3% of whom were female, with a mean age of 40.2 years (range 24-63). Mean preoperative body mass and apnea/hypopnea indexes of ​​sleeve gastrectomy and gastric bypass were respectively 39.9 and 42.8 kg/m2, and 33.7 and 27.7 events/hour. After surgery, mean postoperative body mass and apnea/hypopnea indexes for sleeve gastrectomy and gastric bypass were 28.8 and 30.3 kg/m2, and 7.4 and 9.5 events/hour (0.3-27.3), respectively. Reduction in body mass and apnea/hypopnea indexes in the sleeve gastrectomy group was 27.8% and 74.4%, while in the gastric bypass group it was 29.5% and 62.4%, respectively. There was no statistical difference between the groups regarding sleep apnea control. Conclusion: Both surgical techniques are effective in controlling sleep apnea, with no clear preponderance between them. Participants with higher preoperative BMI were the main beneficiaries. A larger number of patients and studies may corroborate these findings. Health sciences/Diseases Health sciences/Gastroenterology Health sciences/Medical research Health sciences/Risk factors Obesity Management of Obesity Obstructive Sleep Apnea Obesity Hypoventilation Syndrome Metabolic Syndrome Figures Figure 1 INTRODUCTION Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) is among the comorbidities controlled by Bariatric Surgery (BS). Classically involved with overweight, OSAHS can lead to the development of diabetes, secondary arterial hypertension and reduced life expectancy, reinforcing indication of BS. Obesity is the highest known risk factor for OSAHS. ( 1 , 2 )Approximately 35 to 45% of BS candidates have preoperative OSAHS, and approximately 40% of these patients have severe OSAHS.( 3 – 6 ) Pathophysiology between OSAHS and obesity is well elucidated: upper airways have greater tendency to collapse and there is disproportion in body/lung ratio, with decrease in pulmonary compliance.( 7 – 9 ) Increase in neck circumference is due to gain of adipose tissue. In this way, patients develop reduction in airways caliber, with greater need for support pressure for adequate ventilation.( 10 ) Enlarged tongue and displacement of hyoid bone by fat deposition worsen obstructive condition. ( 11 , 12 ) In addition to anatomical factors, obesity contributes to OSAHS through significant metabolic changes. Chronic systemic inflammation and insulin resistance exacerbate effects of OSAHS on cardiovascular system, increasing risk of serious complications such as hypertension and heart disease. ( 13 , 14 ) The best bariatric technique for OSAHS control is discussed. It is expected that techniques with greater metabolic impact will also present better response to the Apnea and Hypopnea Index (AHI). One hypothesis would be that OSAHS control is directly conditioned by patient's weight. Thus, surgery with greater weight impact would also have a better response in controlling apnea. In cohort study involving more than 4000 cases of BS, Currie et al. showed better control of OSAHS through Gastric Bypass (GB) and Sleeve Gastrectomy (SG) when compared to adjustable gastric banding. Quintas-Neves et al., in systematic review involving 22 articles, also demonstrated superiority of mixed vs. restrictive techniques. More rigorous surgeries, such as biliopancreatic diversion, bring better control of the condition, as analyzed in that review. However, this result is debatable, with evidence of equivalence in treatment, or even a slight preponderance of SG over GB. Thus, there is a gap regarding best technical indication for BS regarding the control of OSAHS.( 3 )( 15 )( 16 )( 17 )( 18 – 22 ) This study aims to evaluate evolution of AHI in individuals submitted to GB and SG, with standardized team, to compare AHI between patients of both techniques, to analyze influence of demographic factors on clinical outcomes related to OSAHS, and to investigate relationship between weight loss and clinical improvement of OSAHS symptoms in patients undergoing both surgical techniques. METHODS This is a prospective cohort study with convenience sampling developed at the Hospital Santa Joana Recife Hospital (HSJR), located in Recife, Pernambuco, Brazil. The study has been approved by the Research Ethics Committee of Hospital da Restauração – Recife – Brazil, with the following register number: 5.624.985. All methods were carried out in accordance with brazilian guidelines and regulations, established on Law nº 14.874/2024. Informed consent was obtained from all subjects and/or their legal guardian(s). Surgeries were performed by the same team, composed of four bariatric surgeons and three anesthesiologists. To ensure standardization of treatment, there was continuous participation of three surgeons and two anesthesiologists in each surgery. SG and GB were techniques chosen due to their wide validation and efficacy. Guidelines highlight that GB is highly effective in resolving metabolic diseases, such as type 2 diabetes mellitus, while SG offers similar benefits in weight loss, with lower risk of nutritional complications. Both techniques also demonstrate positive impact on the reduction of AHI. ( 23 – 25 ) Surgical technique did not influence choice of the platform, and both SG and GB could be performed via robotics or laparoscopy. After hospital discharge, patients returned for periodic consultations on the 1st, 3rd, 6th and 12th postoperative months. Following variables were measured: age, gender, body mass index (BMI) -preoperatively and around 6th postoperative month; Apnea/hypopnea index (AHI) - preoperatively and around 6th postoperative month. To ensure accuracy and standardization in data collection, AHI was measured by home polysomnography. In addition, STOP-BANG Questionnaire was applied as screening tool in the preoperative period, due to its good sensitivity in identifying moderate and severe cases of OSAHS. Anthropometric data, such as BMI, were analyzed to correlate weight loss with the clinical outcomes. Inclusion criteria were: Patients with BMI equal to or greater than 35 kg/m²; submitted to BS by videolaparoscopic or robotic platform; History of at least 2 years of unsuccessful clinical treatment of obesity; Diagnosis of preoperative OSAHS. Exclusion criteria: Patients with surgical techniques other than SG or GB; revisional BS; Age under 18 years or over 65 years; severe psychiatric disorders; History of multiple surgical interventions in the upper abdomen, which may hinder surgical procedure; and recent diagnosis of Covid-19 (less than 30 days). Data were measured and computed in a Microsoft Excel table. Data processing and calculations were performed in Social Science Statistics. For interval variables, comparing two samples, for parametric data, we used the Student's t-test. For non-parametric variables, Mann-Whitney test. For correlation of two quantitative variables, Pearson's correlation analysis. Results with statistical significance were those with P lower than 5%. The datasets generated and/or analysed during the current study are not publicly available due to national law (General Data Protection Law) but are available from the corresponding author on reasonable request. RESULTS 30 patients with preoperative OSAHS underwent BS, 18 of whom underwent SG and 12 underwent GB. Two patients in GB group underwent robotic surgery, and the others underwent laparoscopic surgery, as well as all patients in SG group. In order to evaluate homogeneity of biological and clinical characteristics selected for each technique, it was observed that there was no statistically significant difference (p = 0.419) in the comparison of groups in terms of gender distribution, with majority of female patients; however, in comparison of age, GB group had higher mean age (42.9 years) when compared to SG group (36.2 years). Table 1 Comparison of the biological and clinical characteristics of patients undergoing bariatric surgery according to the surgical technique. Characteristics Gastric Bypass (n = 18) Sleeve Gastrectomy (n = 12) p-value Sex 0,419 Female 12 (66,7%) 10 (83,3%) Male 6 (33,3%) 2 (16,7%) Age Average ± SD 42,9 ± 10,1 36,2 ± 8,9 0,076 Surgeon 0,464 A 9 (50,0%) 9 (75,0%) B 5 (27,8%) 2 (16,7%) C 3 (16,7%) 0 (0%) D 1 (5,6%) 1 (8,3%) Pre-surgery BMI Average ± SD 39,9 ± 3,7 42,8 ± 7,7 0,187 AHI – pre-surgical Median (P25 – P75) 28,6 (8,0–56,8) 19,1 (13,0–44,0) 0,767 Time between polysomnography and surgery (in months) Median (P25 – P75) 4,2 (2,3–9,0) 3,1 ( 2 , 4 – 4 , 4 ) 0,289 Statistical significance of age comparison was borderline (p = 0.076), which suggests an age-adjustment analysis in the comparison of outcomes between the groups. There was predominance of performing surgeons, with no significant difference (p = 0.464). There was no significant difference in comparison of preoperative BMI (p = 0.187) and preoperative AHI (p = 0.767) between the groups. Regarding time between polysomnography in the preoperative period and surgery, median time in GB group was 4.2 months and in SG group was 3.1 months, with no statistically significant difference between them (p = 0.289) (Table 1). After surgical procedure, patients were reassessed with new polysomnography and outpatient evaluation with bariatric surgeon, as seen in table 2. Table 2 Comparison of pre- and post-surgical BMI and apnea-hypoapnea index (AHI) of patients undergoing bariatric surgery according to surgical technique. Outcomes Gastric Bypass (n = 18) Sleeve Gastrectomy (n = 12) p-value (between-groups) BMI - Mean ± SD Preoperative 39,9 ± 3,7 42,8 ± 7,7 0,187 Postoperative 28,8 ± 3,1 30,4 ± 7,4 0,414 p-value (intra-group) < 0,001 < 0,001 - Postoperative reduction (kg/m2) 11,2 ± 3,0 12,4 ± 2,7 0,500 Postoperative reduction (%) 27,8 ± 6,3 29,5 ± 6,9 0,500 AHI - Median (P25 – P75) Preoperative (events/hour) 28,6 (8,0–56,8) 19,1 (13,0–44,0) 0,767 Postoperative (events/hour) 5,7 (2,0–10,9) 5,8 ( 1 , 9 – 15 , 4 ) 0,832 p-value (intra-group) < 0,001 0,006 Postoperative reduction (events/hour) 20,3 (5,7–46,0) 11,7 ( 9 , 9 – 27 , 5 ) 0,672 Postoperative reduction (%) 76,7 (67,4–84,1) 70,6 (49,6–87,6) 0,498 Comparing BMI and AHI in the pre- and post-surgical phases in the different techniques (intragroup), a statistically significant reduction (p < 0.001) was observed in both groups, both in BMI and AHI measurements. In GB group there was mean reduction in postoperative BMI of 11.2kg/m 2 , and in percentage terms, this reduction was on average 27.8% of preoperative BMI. In SG group, reduction was an average of 12.4 kg/m2 postoperatively, and in percentage terms this reduction was an average of 29.5%. Comparing the groups, there was no statistically significant difference (p = 0.500) in BMI mean reduction. There was median AHI reduction of 20.3 events/hour in BG group, and in percentage terms this reduction was 76.7%. In SG group, median AHI reduction was 11.7 points, and in percentage terms this median reduction was 70.6%. Comparing groups in relation to AHI reduction, there was no statistically significant difference (p = 0.672) between techniques. None of the patients required postoperative CPAP. Table 3 Crude and adjusted reduction in BMI and apnea-hypoapnea index (AHI) 6 months postoperatively between gastric bypass and sleeve gastrectomy techniques among patients undergoing bariatric surgery according to surgical technique. Outcomes Difference between groups Reduction (95% CI) p-value Age-adjusted between-group difference Reduction (95% CI) p-value BMI Age-adjusted postoperative reduction (kg/m2) 1.22 (-0.98 to 3.34) 0,266 0.97 (-1.39 to 3.33) 0,409 Age-adjusted postoperative reduction (%) 1,69 (-3,33 a 6,67) 0,500 1,31 (-4,07 a 6,70) 0,621 IAH Age-adjusted postoperative reduction 8,15 (-23,8 a 7,5) 0,295 6,21 (-22,9 a 10,5) 0,453 Age-adjusted postoperative reduction (%) 12,0 (-31,7 a 7,7) 0,221 7,8 (-28,4 a 12,9) 0,447 Table 3 presents results of comparison of crude and age-adjusted reduction in BMI and AHI postoperatively between GB and SG groups. There was no significant difference (p > 0.05) between the techniques in any evaluation when adjusted for age. As previously mentioned, the need for adjustment was due to the groups were not homogeneous in terms of age, which could be a confounding factor in estimating reduction in BMI and AHI. These results are summarized in Fig. 1, showing the impact and dispertion of results of both technqiues. Considering the equivalence of both surgical techniques in the literature and the homogeneity of demographic data, as well as similar results mentioned above, correlation analysis between the percentage reductions in AHI and BMI was carried out in order to show the populations that would benefit most from BS, without separating them by technique, as shown in the table 4. Table 4 Analysis of Pearson's correlation between BMI reduction and AHI, both preoperatively and postoperatively. BMI Reduction AHI Reduction Preoperative BMI Preoperative AHI Postoperative BMI Postoperative AHI BMI Reduction PC 1,000 0,477 -0,110 0,218 -0,594 -0,072 p-value 0,008 0,563 0,248 0,001 0,706 AHI Reduction PC 0,477 1,000 -0,465 0,211 -0,639 -0,421 p-value 0,008 0,010 0,263 0,000 0,021 Preoperative BMI PC -0,110 -0,465 1,000 0,397 0,862 0,654 p-value 0,563 0,010 0,030 0,000 0,000 Preoperative AHI PC 0,218 0,211 0,397 1,000 0,179 0,589 p-value 0,248 0,263 0,030 0,343 0,001 Postoperative BMI PC -0,594 -0,639 0,862 0,179 1,000 0,547 p-value 0,001 0,000 0,000 0,343 0,002 Postoperative AHI PC -0,072 -0,421 0,654 0,589 0,547 1,000 p-value 0,706 0,021 0,000 0,001 0,002 AHI reduction showed strong correlation with BMI reduction and with preoperative BMI (p-value of 0.008 and 0.010, respectively), with no clear statistical correlation with the preoperative AHI (p-value of 0.263). DISCUSSION The results of the research were consistent with what has been reported in the literature. In a meta-analysis involving SG, GB and adjustable gastric banding, without division by technique, Mashaqi et al. found reduction in AHI of 23.2, with reduction in BMI of 11.6 kg/m2. Same meta-analysis compared oxygen dissaturation indexes, minimum SaO2, and mean SaO2 in a fraction of the studies, all with evident improvement. ( 24 ) These results reinforce positive impact of BS not only on weight loss, but also on significant improvement of respiratory parameters, corroborating previous data highlighting importance of surgical intervention in risk reduction ssociated with OSAHS. The proportionally greater reduction in AHI compared to BMI reflects the direct influence of fat redistribution in upper airways, especially decreasing cervical circumference. ( 23 , 24 )( 11 , 26 ) AHI reduction of 74.4% in SG patients and 62.4% in GB patients, i.e., a decrease of 26.4 points and 18.2 points, respectively, when compared on average, and 70.6 and 76.7 points, when compared in terms of median, can be justified by shorter follow-up time of our sample, when compared to Mashaqi meta-analysis, which presented articles with follow-up of up to 60 months. In addition, studies indicate that metabolic and hormonal mechanisms modulated by BS can positively influence respiratory outcomes, regardless of length of follow-up. Hormones such as ghrelin and leptin show important changes after BS, with ghrelin showing significant reduction and leptin, related to adipose tissue, also showing reduction proportional to weight loss. These changes impact upper airway regulation and respiratory sensitivity, which may explain the benefits observed even in the short term.( 11 , 26 ) In fact, the proportionally greater reduction in AHI when compared to BMI seems to be related to weight loss, regardless of the form in which it is obtained (lifestyle change, anti-obesity drugs or CB). This may explain the great advantage of BS when compared to non-surgical initiatives, as well as the statistical indifference between SG and GB. These observations highlight that BS acts as intervention with broad metabolic impact, with benefits that go beyond weight loss itself. Improvement in pulmonary function, observed through increased forced vital capacity and oxygen saturation, also corroborates these findings. ( 27 )( 24 )( 26 ) Association between AHI reduction in a more exuberant way than BMI reduction is described in Table 4. In this study, due to statistical equivalence of both surgeries controlling OSAHS, it was possible to add both groups to make inferences about behavior of comorbidity in the face of BS, without segmenting it. AHI and BMI, when compared at the same time (preoperative or postoperative), show a strong correlation, as already discussed, and thus, the reduction of both indices is also extremely and positively correlated, as expected. However, strong negative correlation between preoperative BMI and the proportional reduction in AHI is noteworthy, i.e., the greatest beneficiaries in terms of OSAHS control were precisely those with lower BMI. Thus, it seems to us that BS can be an excellent control option for OSAHS even in those patients with borderline obesity from the weight point of view, as is suggested nowadays with Metabolic Surgery for severe diabetes control. This is possibly the most powerful finding in our study. Results are suggestive that there is also some hormonal/metabolic benefit after BS related specifically to the control of OSAHS. In our experience, patients already show great improvement in sleepiness and snoring even in the first weeks of surgery, although not measured in the study; however, equivalent weight loss, with purely clinical measures, does not seem to reflect in syndromic improvement. Finding laboratory markers to understand this relationship is a source of curiosity and challenge for those who study obesity. ( 28 )( 26 , 29 ) Bariatric surgery is also consistently related to improve sleep architecture. In meta-analysis involving 24 studies in BS patients with OSAHS, a large decrease in AHI, increased oxygen saturation, increased preponderance of REM and N3 sleep, less sleep fragmentation, as well as improved lung function, verified through increased total forced capacity, were evidenced.( 30 ) Improved sleep quality reflects not only AHI reduction, but also better oxygenation and balance of autonomic nervous system. These factors are crucial for overall improvement of quality of life, corroborating positive results reported in our sample. These findings reinforce importance of BS as comprehensive therapeutic approach, with systemic effects including metabolic, respiratory, and neurological improvement. ( 30 , 31 ) Among limitations of the study, we can evidence that all patients underwent polysomnography at home. Although laboratory polysomnography is more accurate in obese patients due to the greater intensity of OSAHS, this diagnosis would hardly be overlooked in home study. ( 32 ) Due to small size of our sample, secondary to difficulty of adherence to postoperative PSG, there was no division or analysis regarding other comorbidities that entail an increased risk of OSAHS. In addition to classic predictors such as higher BMI, male gender, smoking/chronic obstructive pulmonary disease, and older age, other comorbidities can capriciously increase this risk, such as hypothyroidism, gastroesophageal reflux disease, and acromegaly. ( 5 , 32 – 34 ) Currently, there is discussion about indication of magnetic resonance imaging (MRI) for airway evaluation and diagnosis of OSAHS. Through this, it is possible to evaluate retropalatal and retroglossal obstruction, position of hyoid bone, and distance between uvula and tongue. In these cases, in addition to the already presumed diagnosis of OSAHS, MRI would also help in otorhinolaryngological surgical planning. In our sample, a large reduction in AHI was observed in most cases. Thus, there was no complementation with MRI. ( 35 , 36 ) Despite such expressive findings regarding BS control, there is reasonable prevalence of postoperative OSAHS, especially in those patients with more severe preoperative apnea. In prospective multicenter study with 132 participants, prevalence of 20% of moderate/severe OSAHS was found after GB, with cure or improvement in 78% of the patients. This finding is compatible with literature, around 25%.( 37 )( 38 – 40 ) CONCLUSION SG and GB promoted significant reductions in both BMI and AHI, with no statistically significant differences between techniques, even when adjusted for age. None of the patients required postoperative CPAP. In the sample studied, reduction in AHI is strongly and inversely associated with reduction in BMI, as well as with preoperative BMI. Negative correlation between preoperative BMI and AHI reduction suggests that benefits in OSAHS control may be due not only to weight effect, but also to hormonal mechanisms. This finding, which highlights a proportionally more favorable response to AHI reduction in patients with lower preoperative BMI, contributes to discussion about the efficacy of bariatric surgery even in cases of borderline obesity. Future studies with larger samples and longer follow-ups may deepen understanding of mechanisms involved and confirm robustness of these findings. Declarations The datasets generated and/or analysed during the current study are not publicly available due to national Law (General Data Protection Law) but are available from the corresponding author on reasonable request. Author Contribution E. S. N. G., J. L. C., J.M.C. were surgeons who performed the surgeries. F.K., T.F.P.B., A.A.B.F. and J.G.L.V. actively contributed with literature review and discussion. F.K. and A.A.B.F. add insights to methods and statistics analysis. J.G.L.V. has done table and figures. All authores reviewed the manuscript. Acknowledgement I would like to express my sincere gratitude to my colleagues Wagner de Menezes Medeiros Júnior and José Bezerra Câmara Neto for their invaluable support throughout this research. Their contributions and encouragement were essential to the development of this study.I also extend my special thanks to Ulisses Montarroyos for his expertise and assistance in the statistical analysis, which significantly enriched the quality of this work. Data Availability All data supporting the study is hosted at electronic medical record.The datasets generated and/or analysed during the current study are not publicly available due to national Law (General Data Protection Law) but are available from the corresponding author on reasonable request. References Young, T., Peppard, P. E. & Taheri, S. Excess weight and sleep-disordered breathing. 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C. & Bednarik, J. 0572 Weight reduction and the impact on apnea-hypopnea index: a meta-analysis. Sleep [Internet]. 2023 May 1 [cited 2024 Dec 5];46(Supplement_1):A251–2. Available from: https://typeset.io/papers/0572-weight-reduction-and-the-impact-on-apnea-hypopnea-index-3fhj6p7c Day, K. et al. T, et al. Body composition changes and their relationship with obstructive sleep apnoea symptoms, severity: The Sleeping Well Trial. Clinical Nutrition [Internet]. 2023 Sep 1 [cited 2024 Dec 5];42(9):1661–70. Available from: https://typeset.io/papers/body-composition-changes-and-their-relationship-with-1us9dv84qb Furlan, S. F. et al. Three-year effects of bariatric surgery on obstructive sleep apnea in patients with obesity grade 1 and 2: a sub-analysis of the GATEWAY trial. International Journal of Obesity 2021 45:4 [Internet]. 2021 Feb 15 [cited 2022 Feb 22];45(4):914–7. Available from: https://www.nature.com/articles/s41366-021-00752-2 Qin, H. et al. The efficacy of bariatric surgery on pulmonary function and sleep architecture of patients with obstructive sleep apnea and co-morbid obesity: a systematic review and meta-analysis. Surgery for Obesity and Related Diseases [Internet]. 2023 Dec 1 [cited 2024 Sep 4];19(12):1444–57. Available from: https://app.litmaps.com Magne, F. et al. Evolution and Predictive Factors of Improvement of Obstructive Sleep Apnea in an Obese Population After Bariatric Surgery. J Clin Sleep Med [Internet]. Oct 15 [cited 2022 Feb 22];15(10):1509–16. (2019). Available from: https://pubmed.ncbi.nlm.nih.gov/31596217/ van Veldhuisen, S. L. et al. Preoperative Assessment of Obstructive Sleep Apnea in Bariatric Patients Using Polysomnography or Polygraphy. Obes Surg [Internet]. 2022 Jun 1 [cited 2024 Sep 4];32(6):1814–21. Available from: https://link.springer.com/ article/10.1007/s11695-022-06038-4 Erridge, S. et al. Obstructive Sleep Apnea in Obese Patients: a UK Population Analysis. Obes Surg [Internet]. 2021 May 1 [cited 2024 Sep 4];31(5):1986–93. Available from: https://link.springer.com/article/ 10.1007/s11695-020-05196-7 Chen, W., Feng, J., Wang, Y., Wang, C. & Dong, Z. Development and Validation of a Nomogram for Predicting Obstructive Sleep Apnea in Bariatric Surgery Candidates. Nat Sci Sleep [Internet]. [cited 2022 Feb 22];13:1013–23. (2021). Available from: https://pubmed.ncbi.nlm.nih.gov/34234604/ Li, Y. et al. Characteristics and Mechanism of Upper Airway Collapse Revealed by Dynamic MRI During Natural Sleep in Patients with Severe Obstructive Sleep Apnea. Nat Sci Sleep [Internet]. 2023 Nov 1 [cited 2024 Sep 4];15:885–902. Available from: https://www.dovepress.com/characteristics-and-mechanism-of-upper-airway-collapse-revealed-by-dyn-peer-reviewed-fulltext-article-NSS Gamaleldin, O. et al. Role of dynamic sleep MRI in obstructive sleep apnea syndrome. Oral Radiol [Internet]. 2021 Jul 1 [cited 2024 Sep 4];37(3):376–84. Available from: https://link.springer.com/article/ 10.1007/s11282-020-00455-w Peromaa-Haavisto, P. et al. Obstructive sleep apnea: the effect of bariatric surgery after 12 months. A prospective multicenter trial. Sleep Med [Internet]. 2017 Jul 1 [cited 2024 Dec 5];35:85–90. Available from: https://pubmed.ncbi.nlm.nih.gov/28549834/ de Raaff, C. A. L. et al. Persistent moderate or severe obstructive sleep apnea after laparoscopic Roux-en-Y gastric bypass: which patients? Surg Obes Relat Dis [Internet]. 2016 Dec 1 [cited 2024 Dec 5];12(10):1866–72. Available from: https://pubmed.ncbi.nlm.nih.gov/27234342/ Demaeyer, N. & Bruyneel, M. Factors Associated with Persistent Obstructive Sleep Apnea After Bariatric Surgery: A Narrative Review. Nat Sci Sleep [Internet]. [cited 2024 Dec 5];16:111–23. (2024). Available from: https://pubmed.ncbi.nlm.nih.gov/38348054/ Yang, J., Qiao, Y., Wu, L. & Wu, Z. Sleeve Gastrectomy Surgery makes Obstructive Sleep Apnea Worse or Better? a Multi-Center Observational Study in Patients with Obesity. Obes Surg [Internet]. 2024 Feb 1 [cited 2024 Dec 5];34(2):409–15. Available from: https://pubmed.ncbi.nlm.nih.gov/38165528/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7011881","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":489950625,"identity":"ba502ebb-feb1-4f35-a824-6695a17f631b","order_by":0,"name":"Eduardo Sávio Nascimento Godoy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYFCCBCBmAzGYDwAJCRlStLCBWBI8pGjhMQCTBDXws+cYfq4os7E351/z+dWNGgseBvbDRzfg0yLZ88ZY8sy5tMSdM95us845BnQYT1raDXxaDG7kGEg2th1OMLhxdptxDhtQiwSPGV4t9jdyjH8Ctdgb3DjzzDjnHxFaDCRyzEC2MG4438P8OLeNCC0SZ56VWTYA/bLhBpsZc26fBA8bIb/wtydvvtkADDGD84cff875VifHz374GF4tSPYlsEmAaDbilIPtO8D8gXjVo2AUjIJRMJIAALz4SYlO4yN5AAAAAElFTkSuQmCC","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":true,"prefix":"","firstName":"Eduardo","middleName":"Sávio Nascimento","lastName":"Godoy","suffix":""},{"id":489950627,"identity":"39a4846c-8cf1-451c-a58a-56fe7293e477","order_by":1,"name":"Flávio Kreimer","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Flávio","middleName":"","lastName":"Kreimer","suffix":""},{"id":489950628,"identity":"a504c9a9-f589-40bf-86d2-6ee0399b3fad","order_by":2,"name":"Thiago Freire Pinto Bezerra","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Thiago","middleName":"Freire Pinto","lastName":"Bezerra","suffix":""},{"id":489950629,"identity":"05e3f117-45d3-4eb1-9b15-45a628d56277","order_by":3,"name":"Josemberg Marins Campos","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Josemberg","middleName":"Marins","lastName":"Campos","suffix":""},{"id":489950630,"identity":"200ca809-6b7b-4919-9f23-2fac1ea94a7c","order_by":4,"name":"Josemir Lessa Carvalho","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Josemir","middleName":"Lessa","lastName":"Carvalho","suffix":""},{"id":489950631,"identity":"2dba37cf-1b26-424a-b39c-7a653048b994","order_by":5,"name":"Álvaro Antonio Bandeira Ferraz","email":"","orcid":"","institution":"Federal University of Pernambuco","correspondingAuthor":false,"prefix":"","firstName":"Álvaro","middleName":"Antonio Bandeira","lastName":"Ferraz","suffix":""},{"id":489950632,"identity":"11a085ee-c50f-4e52-a6aa-c0e7bb2bda47","order_by":6,"name":"José Gabriel Linhares Vieira","email":"","orcid":"","institution":"Instituto de Medicina Integral Professor Fernando Figueira","correspondingAuthor":false,"prefix":"","firstName":"José","middleName":"Gabriel Linhares","lastName":"Vieira","suffix":""}],"badges":[],"createdAt":"2025-06-30 14:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7011881/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7011881/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87699151,"identity":"8d49eca4-1fa0-490c-9171-a42d9adb58e5","added_by":"auto","created_at":"2025-07-28 07:05:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":148834,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBMI and apnea-hypoapnea index (AHI) measurements of pre- and post-surgical patients undergoing bariatric surgery according to surgical technique.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7011881/v1/e7e7dbd10568848158a879e7.jpg"},{"id":89881344,"identity":"8e62c9fe-c196-4943-8780-a3052461119b","added_by":"auto","created_at":"2025-08-26 05:54:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1080553,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7011881/v1/a2bb4bcc-d7f6-4bf4-89b1-accee15deb08.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImpact of Bariatric Surgery on Control of Obstructive Sleep Apnea and Hypopnea Syndrome: Comparison Between Gastric Bypass and Sleeve Gastrectomy\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eObstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) is among the comorbidities controlled by Bariatric Surgery (BS). Classically involved with overweight, OSAHS can lead to the development of diabetes, secondary arterial hypertension and reduced life expectancy, reinforcing indication of BS. Obesity is the highest known risk factor for OSAHS. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)Approximately 35 to 45% of BS candidates have preoperative OSAHS, and approximately 40% of these patients have severe OSAHS.(\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003cp\u003ePathophysiology between OSAHS and obesity is well elucidated: upper airways have greater tendency to collapse and there is disproportion in body/lung ratio, with decrease in pulmonary compliance.(\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Increase in neck circumference is due to gain of adipose tissue. In this way, patients develop reduction in airways caliber, with greater need for support pressure for adequate ventilation.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Enlarged tongue and displacement of hyoid bone by fat deposition worsen obstructive condition. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIn addition to anatomical factors, obesity contributes to OSAHS through significant metabolic changes. Chronic systemic inflammation and insulin resistance exacerbate effects of OSAHS on cardiovascular system, increasing risk of serious complications such as hypertension and heart disease. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe best bariatric technique for OSAHS control is discussed. It is expected that techniques with greater metabolic impact will also present better response to the Apnea and Hypopnea Index (AHI). One hypothesis would be that OSAHS control is directly conditioned by patient's weight. Thus, surgery with greater weight impact would also have a better response in controlling apnea. In cohort study involving more than 4000 cases of BS, Currie et al. showed better control of OSAHS through Gastric Bypass (GB) and Sleeve Gastrectomy (SG) when compared to adjustable gastric banding. Quintas-Neves et al., in systematic review involving 22 articles, also demonstrated superiority of mixed vs. restrictive techniques. More rigorous surgeries, such as biliopancreatic diversion, bring better control of the condition, as analyzed in that review. However, this result is debatable, with evidence of equivalence in treatment, or even a slight preponderance of SG over GB. Thus, there is a gap regarding best technical indication for BS regarding the control of OSAHS.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)(\u003cspan additionalcitationids=\"CR19 CR20 CR21\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThis study aims to evaluate evolution of AHI in individuals submitted to GB and SG, with standardized team, to compare AHI between patients of both techniques, to analyze influence of demographic factors on clinical outcomes related to OSAHS, and to investigate relationship between weight loss and clinical improvement of OSAHS symptoms in patients undergoing both surgical techniques.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis is a prospective cohort study with convenience sampling developed at the Hospital Santa Joana Recife Hospital (HSJR), located in Recife, Pernambuco, Brazil. The study has been approved by the Research Ethics Committee of Hospital da Restaura\u0026ccedil;\u0026atilde;o \u0026ndash; Recife \u0026ndash; Brazil, with the following register number: 5.624.985.\u003c/p\u003e\u003cp\u003e All methods were carried out in accordance with brazilian guidelines and regulations, established on Law n\u0026ordm; 14.874/2024. Informed consent was obtained from all subjects and/or their legal guardian(s).\u003c/p\u003e\u003cp\u003eSurgeries were performed by the same team, composed of four bariatric surgeons and three anesthesiologists. To ensure standardization of treatment, there was continuous participation of three surgeons and two anesthesiologists in each surgery.\u003c/p\u003e\u003cp\u003eSG and GB were techniques chosen due to their wide validation and efficacy. Guidelines highlight that GB is highly effective in resolving metabolic diseases, such as type 2 diabetes mellitus, while SG offers similar benefits in weight loss, with lower risk of nutritional complications. Both techniques also demonstrate positive impact on the reduction of AHI. (\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eSurgical technique did not influence choice of the platform, and both SG and GB could be performed via robotics or laparoscopy. After hospital discharge, patients returned for periodic consultations on the 1st, 3rd, 6th and 12th postoperative months.\u003c/p\u003e\u003cp\u003eFollowing variables were measured: age, gender, body mass index (BMI) -preoperatively and around 6th postoperative month; Apnea/hypopnea index (AHI) - preoperatively and around 6th postoperative month. To ensure accuracy and standardization in data collection, AHI was measured by home polysomnography. In addition, STOP-BANG Questionnaire was applied as screening tool in the preoperative period, due to its good sensitivity in identifying moderate and severe cases of OSAHS. Anthropometric data, such as BMI, were analyzed to correlate weight loss with the clinical outcomes.\u003c/p\u003e\u003cp\u003eInclusion criteria were: Patients with BMI equal to or greater than 35 kg/m\u0026sup2;; submitted to BS by videolaparoscopic or robotic platform; History of at least 2 years of unsuccessful clinical treatment of obesity; Diagnosis of preoperative OSAHS. Exclusion criteria: Patients with surgical techniques other than SG or GB; revisional BS; Age under 18 years or over 65 years; severe psychiatric disorders; History of multiple surgical interventions in the upper abdomen, which may hinder surgical procedure; and recent diagnosis of Covid-19 (less than 30 days).\u003c/p\u003e\u003cp\u003eData were measured and computed in a Microsoft Excel table. Data processing and calculations were performed in Social Science Statistics. For interval variables, comparing two samples, for parametric data, we used the Student's t-test. For non-parametric variables, Mann-Whitney test. For correlation of two quantitative variables, Pearson's correlation analysis. Results with statistical significance were those with P lower than 5%. The datasets generated and/or analysed during the current study are not publicly available due to national law (General Data Protection Law) but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e30 patients with preoperative OSAHS underwent BS, 18 of whom underwent SG and 12 underwent GB. Two patients in GB group underwent robotic surgery, and the others underwent laparoscopic surgery, as well as all patients in SG group. In order to evaluate homogeneity of biological and clinical characteristics selected for each technique, it was observed that there was no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.419) in the comparison of groups in terms of gender distribution, with majority of female patients; however, in comparison of age, GB group had higher mean age (42.9 years) when compared to SG group (36.2 years).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of the biological and clinical characteristics of patients undergoing bariatric surgery according to the surgical technique.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGastric Bypass\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSleeve Gastrectomy\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,419\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (66,7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (83,3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (33,3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (16,7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42,9\u0026thinsp;\u0026plusmn;\u0026thinsp;10,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36,2\u0026thinsp;\u0026plusmn;\u0026thinsp;8,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgeon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,464\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (50,0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (75,0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (27,8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (16,7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (16,7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (5,6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (8,3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-surgery BMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39,9\u0026thinsp;\u0026plusmn;\u0026thinsp;3,7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42,8\u0026thinsp;\u0026plusmn;\u0026thinsp;7,7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,187\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAHI \u0026ndash; pre-surgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian (P25 \u0026ndash; P75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28,6 (8,0\u0026ndash;56,8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19,1 (13,0\u0026ndash;44,0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,767\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime between polysomnography and surgery (in months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian (P25 \u0026ndash; P75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4,2 (2,3\u0026ndash;9,0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,1 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0,289\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eStatistical significance of age comparison was borderline (p\u0026thinsp;=\u0026thinsp;0.076), which suggests an age-adjustment analysis in the comparison of outcomes between the groups. There was predominance of performing surgeons, with no significant difference (p\u0026thinsp;=\u0026thinsp;0.464). There was no significant difference in comparison of preoperative BMI (p\u0026thinsp;=\u0026thinsp;0.187) and preoperative AHI (p\u0026thinsp;=\u0026thinsp;0.767) between the groups. Regarding time between polysomnography in the preoperative period and surgery, median time in GB group was 4.2 months and in SG group was 3.1 months, with no statistically significant difference between them (p\u0026thinsp;=\u0026thinsp;0.289) (Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eAfter surgical procedure, patients were reassessed with new polysomnography and outpatient evaluation with bariatric surgeon, as seen in table 2.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of pre- and post-surgical BMI and apnea-hypoapnea index (AHI) of patients undergoing bariatric surgery according to surgical technique.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcomes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGastric Bypass\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSleeve Gastrectomy\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003cp\u003e(between-groups)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI - Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39,9\u0026thinsp;\u0026plusmn;\u0026thinsp;3,7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42,8\u0026thinsp;\u0026plusmn;\u0026thinsp;7,7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,187\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28,8\u0026thinsp;\u0026plusmn;\u0026thinsp;3,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30,4\u0026thinsp;\u0026plusmn;\u0026thinsp;7,4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,414\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ep-value (intra-group)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative reduction (kg/m2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11,2\u0026thinsp;\u0026plusmn;\u0026thinsp;3,0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12,4\u0026thinsp;\u0026plusmn;\u0026thinsp;2,7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,500\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative reduction (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27,8\u0026thinsp;\u0026plusmn;\u0026thinsp;6,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29,5\u0026thinsp;\u0026plusmn;\u0026thinsp;6,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,500\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAHI - Median (P25 \u0026ndash; P75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003cp\u003e(events/hour)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28,6 (8,0\u0026ndash;56,8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19,1 (13,0\u0026ndash;44,0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,767\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative\u003c/p\u003e\u003cp\u003e(events/hour)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,7 (2,0\u0026ndash;10,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5,8 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,832\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ep-value (intra-group)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0,006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative reduction (events/hour)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20,3 (5,7\u0026ndash;46,0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11,7 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,672\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative reduction (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76,7 (67,4\u0026ndash;84,1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70,6 (49,6\u0026ndash;87,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,498\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eComparing BMI and AHI in the pre- and post-surgical phases in the different techniques (intragroup), a statistically significant reduction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was observed in both groups, both in BMI and AHI measurements. In GB group there was mean reduction in postoperative BMI of 11.2kg/m\u003csup\u003e2\u003c/sup\u003e, and in percentage terms, this reduction was on average 27.8% of preoperative BMI. In SG group, reduction was an average of 12.4 kg/m2 postoperatively, and in percentage terms this reduction was an average of 29.5%. Comparing the groups, there was no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.500) in BMI mean reduction.\u003c/p\u003e\u003cp\u003eThere was median AHI reduction of 20.3 events/hour in BG group, and in percentage terms this reduction was 76.7%. In SG group, median AHI reduction was 11.7 points, and in percentage terms this median reduction was 70.6%. Comparing groups in relation to AHI reduction, there was no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.672) between techniques.\u003c/p\u003e\u003cp\u003eNone of the patients required postoperative CPAP.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCrude and adjusted reduction in BMI and apnea-hypoapnea index (AHI) 6 months postoperatively between gastric bypass and sleeve gastrectomy techniques among patients undergoing bariatric surgery according to surgical technique.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcomes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDifference between groups\u003c/p\u003e\u003cp\u003eReduction (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge-adjusted between-group difference\u003c/p\u003e\u003cp\u003eReduction (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge-adjusted postoperative reduction (kg/m2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.22 (-0.98 to 3.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.97 (-1.39 to 3.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,409\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge-adjusted postoperative reduction (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,69 (-3,33 a 6,67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,31 (-4,07 a 6,70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,621\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIAH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge-adjusted postoperative reduction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8,15 (-23,8 a 7,5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6,21 (-22,9 a 10,5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,453\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge-adjusted postoperative reduction (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12,0 (-31,7 a 7,7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0,221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7,8 (-28,4 a 12,9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,447\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;3 presents results of comparison of crude and age-adjusted reduction in BMI and AHI postoperatively between GB and SG groups. There was no significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) between the techniques in any evaluation when adjusted for age. As previously mentioned, the need for adjustment was due to the groups were not homogeneous in terms of age, which could be a confounding factor in estimating reduction in BMI and AHI.\u003c/p\u003e\u003cp\u003eThese results are summarized in Fig.\u0026nbsp;1, showing the impact and dispertion of results of both technqiues.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eConsidering the equivalence of both surgical techniques in the literature and the homogeneity of demographic data, as well as similar results mentioned above, correlation analysis between the percentage reductions in AHI and BMI was carried out in order to show the populations that would benefit most from BS, without separating them by technique, as shown in the table 4.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnalysis of Pearson's correlation between BMI reduction and AHI, both preoperatively and postoperatively.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBMI Reduction\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAHI Reduction\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePreoperative BMI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePreoperative AHI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePostoperative BMI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePostoperative AHI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI Reduction\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,477\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0,110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0,218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0,594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0,072\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,563\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0,248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0,706\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAHI Reduction\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,477\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0,465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0,211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0,639\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0,421\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0,263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0,021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePreoperative BMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0,110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0,465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0,397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,862\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0,654\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,563\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0,030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0,000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePreoperative AHI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0,589\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,343\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0,001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative BMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0,594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0,639\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,862\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0,179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0,547\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0,343\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0,002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative AHI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0,072\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0,421\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,654\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0,589\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,547\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1,000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,706\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0,001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAHI reduction showed strong correlation with BMI reduction and with preoperative BMI (p-value of 0.008 and 0.010, respectively), with no clear statistical correlation with the preoperative AHI (p-value of 0.263).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe results of the research were consistent with what has been reported in the literature. In a meta-analysis involving SG, GB and adjustable gastric banding, without division by technique, Mashaqi et al. found reduction in AHI of 23.2, with reduction in BMI of 11.6 kg/m2. Same meta-analysis compared oxygen dissaturation indexes, minimum SaO2, and mean SaO2 in a fraction of the studies, all with evident improvement. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThese results reinforce positive impact of BS not only on weight loss, but also on significant improvement of respiratory parameters, corroborating previous data highlighting importance of surgical intervention in risk reduction ssociated with OSAHS. The proportionally greater reduction in AHI compared to BMI reflects the direct influence of fat redistribution in upper airways, especially decreasing cervical circumference. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAHI reduction of 74.4% in SG patients and 62.4% in GB patients, i.e., a decrease of 26.4 points and 18.2 points, respectively, when compared on average, and 70.6 and 76.7 points, when compared in terms of median, can be justified by shorter follow-up time of our sample, when compared to Mashaqi meta-analysis, which presented articles with follow-up of up to 60 months.\u003c/p\u003e\u003cp\u003eIn addition, studies indicate that metabolic and hormonal mechanisms modulated by BS can positively influence respiratory outcomes, regardless of length of follow-up. Hormones such as ghrelin and leptin show important changes after BS, with ghrelin showing significant reduction and leptin, related to adipose tissue, also showing reduction proportional to weight loss. These changes impact upper airway regulation and respiratory sensitivity, which may explain the benefits observed even in the short term.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIn fact, the proportionally greater reduction in AHI when compared to BMI seems to be related to weight loss, regardless of the form in which it is obtained (lifestyle change, anti-obesity drugs or CB). This may explain the great advantage of BS when compared to non-surgical initiatives, as well as the statistical indifference between SG and GB. These observations highlight that BS acts as intervention with broad metabolic impact, with benefits that go beyond weight loss itself. Improvement in pulmonary function, observed through increased forced vital capacity and oxygen saturation, also corroborates these findings. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAssociation between AHI reduction in a more exuberant way than BMI reduction is described in Table\u0026nbsp;4. In this study, due to statistical equivalence of both surgeries controlling OSAHS, it was possible to add both groups to make inferences about behavior of comorbidity in the face of BS, without segmenting it. AHI and BMI, when compared at the same time (preoperative or postoperative), show a strong correlation, as already discussed, and thus, the reduction of both indices is also extremely and positively correlated, as expected. However, strong negative correlation between preoperative BMI and the proportional reduction in AHI is noteworthy, i.e., the greatest beneficiaries in terms of OSAHS control were precisely those with lower BMI. Thus, it seems to us that BS can be an excellent control option for OSAHS even in those patients with borderline obesity from the weight point of view, as is suggested nowadays with Metabolic Surgery for severe diabetes control. This is possibly the most powerful finding in our study.\u003c/p\u003e\u003cp\u003eResults are suggestive that there is also some hormonal/metabolic benefit after BS related specifically to the control of OSAHS. In our experience, patients already show great improvement in sleepiness and snoring even in the first weeks of surgery, although not measured in the study; however, equivalent weight loss, with purely clinical measures, does not seem to reflect in syndromic improvement. Finding laboratory markers to understand this relationship is a source of curiosity and challenge for those who study obesity. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eBariatric surgery is also consistently related to improve sleep architecture. In meta-analysis involving 24 studies in BS patients with OSAHS, a large decrease in AHI, increased oxygen saturation, increased preponderance of REM and N3 sleep, less sleep fragmentation, as well as improved lung function, verified through increased total forced capacity, were evidenced.(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eImproved sleep quality reflects not only AHI reduction, but also better oxygenation and balance of autonomic nervous system. These factors are crucial for overall improvement of quality of life, corroborating positive results reported in our sample. These findings reinforce importance of BS as comprehensive therapeutic approach, with systemic effects including metabolic, respiratory, and neurological improvement. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAmong limitations of the study, we can evidence that all patients underwent polysomnography at home. Although laboratory polysomnography is more accurate in obese patients due to the greater intensity of OSAHS, this diagnosis would hardly be overlooked in home study. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDue to small size of our sample, secondary to difficulty of adherence to postoperative PSG, there was no division or analysis regarding other comorbidities that entail an increased risk of OSAHS. In addition to classic predictors such as higher BMI, male gender, smoking/chronic obstructive pulmonary disease, and older age, other comorbidities can capriciously increase this risk, such as hypothyroidism, gastroesophageal reflux disease, and acromegaly. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eCurrently, there is discussion about indication of magnetic resonance imaging (MRI) for airway evaluation and diagnosis of OSAHS. Through this, it is possible to evaluate retropalatal and retroglossal obstruction, position of hyoid bone, and distance between uvula and tongue. In these cases, in addition to the already presumed diagnosis of OSAHS, MRI would also help in otorhinolaryngological surgical planning. In our sample, a large reduction in AHI was observed in most cases. Thus, there was no complementation with MRI. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDespite such expressive findings regarding BS control, there is reasonable prevalence of postoperative OSAHS, especially in those patients with more severe preoperative apnea. In prospective multicenter study with 132 participants, prevalence of 20% of moderate/severe OSAHS was found after GB, with cure or improvement in 78% of the patients. This finding is compatible with literature, around 25%.(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)(\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eSG and GB promoted significant reductions in both BMI and AHI, with no statistically significant differences between techniques, even when adjusted for age. None of the patients required postoperative CPAP.\u003c/p\u003e\u003cp\u003eIn the sample studied, reduction in AHI is strongly and inversely associated with reduction in BMI, as well as with preoperative BMI.\u003c/p\u003e\u003cp\u003eNegative correlation between preoperative BMI and AHI reduction suggests that benefits in OSAHS control may be due not only to weight effect, but also to hormonal mechanisms. This finding, which highlights a proportionally more favorable response to AHI reduction in patients with lower preoperative BMI, contributes to discussion about the efficacy of bariatric surgery even in cases of borderline obesity. Future studies with larger samples and longer follow-ups may deepen understanding of mechanisms involved and confirm robustness of these findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cb\u003eThe datasets generated and/or analysed during the current study are not publicly available due to national Law (General Data Protection Law) but are available from the corresponding author on reasonable request.\u003c/b\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE. S. N. G., J. L. C., J.M.C. were surgeons who performed the surgeries. F.K., T.F.P.B., A.A.B.F. and J.G.L.V. actively contributed with literature review and discussion. F.K. and A.A.B.F. add insights to methods and statistics analysis. J.G.L.V. has done table and figures. All authores reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eI would like to express my sincere gratitude to my colleagues Wagner de Menezes Medeiros J\u0026uacute;nior and Jos\u0026eacute; Bezerra C\u0026acirc;mara Neto for their invaluable support throughout this research. Their contributions and encouragement were essential to the development of this study.I also extend my special thanks to Ulisses Montarroyos for his expertise and assistance in the statistical analysis, which significantly enriched the quality of this work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data supporting the study is hosted at electronic medical record.The datasets generated and/or analysed during the current study are not publicly available due to national Law (General Data Protection Law) but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYoung, T., Peppard, P. E. \u0026amp; Taheri, S. Excess weight and sleep-disordered breathing. J Appl Physiol [Internet]. 2005 Oct [cited 2022 Feb 27];99(4):1592\u0026ndash;9. (1985). 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Factors Associated with Persistent Obstructive Sleep Apnea After Bariatric Surgery: A Narrative Review. Nat Sci Sleep [Internet]. [cited 2024 Dec 5];16:111\u0026ndash;23. (2024). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/38348054/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/38348054/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang, J., Qiao, Y., Wu, L. \u0026amp; Wu, Z. Sleeve Gastrectomy Surgery makes Obstructive Sleep Apnea Worse or Better? a Multi-Center Observational Study in Patients with Obesity. Obes Surg [Internet]. 2024 Feb 1 [cited 2024 Dec 5];34(2):409\u0026ndash;15. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/38165528/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/38165528/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Obesity, Management of Obesity, Obstructive Sleep Apnea, Obesity Hypoventilation Syndrome, Metabolic Syndrome","lastPublishedDoi":"10.21203/rs.3.rs-7011881/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7011881/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Bariatric surgery is well-established treatment for grade 2 and 3 obesity refractory to clinical measures. Obstructive Sleep and Apnea Hypopnea Syndrome is among the comorbidities controlled by bariatric surgery. Patients undergoing bariatric surgery show global improvement in respiratory function. However, there is no formal indication of a specific surgical technique for better control of apnea.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To evaluate the evolution of apnea/hypopnea indices, associated with weight loss, in individuals undergoing two bariatric surgery techniques: Sleeve Gastrectomy and Gastric Bypass.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Prospective cohort carried out at Hospital Santa Joana Recife – Pernambuco - Brazil, including obese patients with Sleep Apnea and Hypopnea Syndrome undergoing bariatric surgery, for pre- and postoperative evaluation through polysomnography. Body mass and apnea/hypopnea indexes were measured pre- and postoperatively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: 30 participants were selected, 18 of whom underwent Sleeve Gastrectomy and 12 underwent Gastric Bypass, 73.3% of whom were female, with a mean age of 40.2 years (range 24-63). Mean preoperative body mass and apnea/hypopnea indexes of ​​sleeve gastrectomy and gastric bypass were respectively 39.9 and 42.8 kg/m2, and 33.7 and 27.7 events/hour. After surgery, mean postoperative body mass and apnea/hypopnea indexes for sleeve gastrectomy and gastric bypass were 28.8 and 30.3 kg/m2, and 7.4 and 9.5 events/hour (0.3-27.3), respectively. Reduction in body mass and apnea/hypopnea indexes in the sleeve gastrectomy group was 27.8% and 74.4%, while in the gastric bypass group it was 29.5% and 62.4%, respectively. There was no statistical difference between the groups regarding sleep apnea control.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eBoth surgical techniques are effective in controlling sleep apnea, with no clear preponderance between them. Participants with higher preoperative BMI were the main beneficiaries. A larger number of patients and studies may corroborate these findings.\u003c/p\u003e","manuscriptTitle":"Impact of Bariatric Surgery on Control of Obstructive Sleep Apnea and Hypopnea Syndrome: Comparison Between Gastric Bypass and Sleeve Gastrectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-28 07:05:43","doi":"10.21203/rs.3.rs-7011881/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a10f512b-36b7-4374-aff0-f02e034ee53d","owner":[],"postedDate":"July 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52064671,"name":"Health sciences/Diseases"},{"id":52064672,"name":"Health sciences/Gastroenterology"},{"id":52064673,"name":"Health sciences/Medical research"},{"id":52064674,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-08-26T05:53:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-28 07:05:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7011881","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7011881","identity":"rs-7011881","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}