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Roux-en-Y gastric bypass or sleeve gastrectomy for obstructive sleep apnea:A systematic review and meta-analysis

查看全文 作　　者：Hussein Al-[1]Rubaye;Emma Rose [2]McGlone;Borna [1]Farzaneh;Livyar [1]Mustafa;Mae [3]Johnson;Ajit [3]Kayal;Caroline-Louise [4]English;Vasha [2]Kaur;Myutan [4]Kalendran;Marcus [5]Reddy;Omar [5,6]A.Khan 高影响力作者 机构地区：[1]St George's,University of London,London,SW170RE,UK;[2]Department of Metabolic and Investigative Medicine,Hammersmith Hospital Campus,Imperial College London,London,W120HS,UK;[3]Department of Anaesthetic,St George's Hospital,London,SW170QT,UK;[4]St George's Hospital,London,SW170QT,UK;[5]Department of Upper Gastrointestinal and Bariatric Surgery,St George's Hospital,London,SW170QT,UK;[6]Population Health Research Institute,St George's,University of London,London,SW170RE,UK高影响力机构 出　　处：《Laparoscopic, Endoscopic and Robotic Surgery》索引2019年第2卷第3期,共6页高影响力期刊 基　　金：The study was pre-registered with the Prospective Register of Systematic Reviews,PROSPERO identification code:CRD42018090367. 摘　　要：Objective:Bariatric surgery has been shown to be an effective method of treatment for obstructive sleep apnea(OSA)with long-term benefits,however,the mechanisms of action and the optimum operative procedure remains unclear.The aim of this systemic review was to compare the efficacy of laparoscopic sleeve gastrectomy(LSG)and Roux-en-Y gastric bypass(RYGB)in resolving OSA.Methods:A comprehensive search of MEDLINE,Pubmed,Embase,and OVID was performed.Studies that reported OSA resolution in obese patients with BMI>30 kg/m2 were included in the study.RCTs,comparative prospective and matched cohort studies comparing RYGB with LSG were considered for this study.Results:Five studies(309 participants)were included:4 cohort studies and 1 RCT;all with low risk of bias.At 12 months follow-up,there was a trend towards improved resolution of OSA with LSG(OR 0.47,95%CI[0.20 to 1.06];p=0.07)when compared to RYGB.In contrast,there was a trend to poorer weight loss in the LSG group(SMD 3.83,95%CI[-1.82 to 9.48];p=0.18).Similarly,at 36 months follow-up,there was a trend towards better resolution of OSA with LSG(OR 0.52,95%CI[0.16 to 1.71];p=0.28)and a significantly poorer weight loss in LSG when compared to RYGB(SMD 8.25,95%CI[2.91 to 13.58];p=0.002).Conclusion:Despite poorer weight loss following LSG,there is a trend towards increased resolution of sleep apnea post-LSG.These findings suggest the possibility of weight loss independent factors causing OSA resolution,which should be further investigated.Registration:PROSPERO:CRD42018090367. 关 键 词：OBESITY Laparoscopic sleeve gastrectomy Laparoscopic Roux-en-Y gastric bypass Obstructive sleep apnea META-ANALYSIS
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