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Obesity is associated with significant increased risk of obstructive sleep apnoea (OSA). Bariatric surgery can potentially reduce the BMI which can help to resolve OSA 10% increase in body weight increases risk of OSA x6 fold and worsen apnoea hypopnoea index (AHI) by 32% over 4 yrs. (Young et aal,NEJM 1993) A 10% weight loss can reduce AHI by 26% Meta-analysis shows that >80% would have improvement in OSA (Buchwald, JAMA 2004) Varying reports in literature regarding outcomes of OSA after weight loss  Resolution of OSA can sometimes be as quick as within the first month after bariatric surgery (Varela et al, Obes surgery 2007)  However OS A can still persist and require treatment 1 year after bariatric surgery  Apnoea/ hypopnoea index reduces with bariatric surgery but may not account for complete resolution  RCT comparing bariatric surgery vs conventional treatment showing some reduction but no significant improvement in OSA (Dixon et al, JAMA 2012) The improvement of OSA is multifactorial – due to weight loss, reduced insulin resistance, change in sex hormone levels, reduced cytokines and gut hormone profile (Ashrafian et al, Thorax 2011)

Obstructive sleep apnoea and bariatric surgery: the need for more universal screening and post-operative follow up