Anatomical Remodeling of the Upper Airway after Laparoscopic Sleeve Gastrectomy: A Multimodal Assessment of Structural and Functional Improvements in Obstructive Sleep Apnea.

INTRODUCTION: Obstructive Sleep Apnea (OSA) represents a significant global health challenge, closely linked to obesity and a heightened risk for cardiovascular and metabolic disorders. Continuous Positive Airway Pressure (CPAP) remains the cornerstone of OSA management; however, its effectiveness is often hindered by patient adherence and tolerance. Metabolic and bariatric surgery (MBS) has emerged as a viable alternative by reducing excess weight and improving upper airway anatomy. Among the various MBS techniques, Sleeve Gastrectomy (SG) has gained prominence due to its favorable outcomes and limited complications. This study aims to assess the impact of SG on OSA, utilizing Magnetic Resonance Imaging (MRI) and polysomnography to analyze structural changes and clinical outcomes. METHODS: In this prospective study, 40 participants aged 18-65 years with a BMI exceeding 30 kg/m² and a confirmed diagnosis of OSA (apnea-hypopnea index [AHI] ≥ 5) were enrolled. Pre- and post-operative evaluations included an MRI of the upper airway, polysomnography, and the Epworth Sleepiness Scale (ESS) to quantify daytime somnolence. Statistical analysis was conducted using Generalized Estimating Equations (GEE) and correlation tests in R software, focusing on changes in weight, BMI, AHI, Oxygen Desaturation Index (ODI), and airway dimensions. RESULTS: Post-SG, participants exhibited significant weight reduction, averaging - 43.8 kg (p < 0.001), and a decrease in BMI of -15.7 kg/m² (p < 0.001). Both AHI and ODI demonstrated significant declines (p < 0.001), with daytime sleepiness normalizing in all subjects. MRI analysis indicated notable increases in upper airway dimensions coupled with a reduction in tongue volume. Additionally, CPAP reliance decreased from 90% to 22.5%. Remarkably, diabetes and hypertension were resolved in all subjects. CONCLUSION: This study suggests that SG may yield 12-month improvements in OSA severity, upper airway structure, and CPAP dependency in patients with obesity. The findings highlight SG as a potentially valuable adjunct treatment, although larger, long-term studies are warranted to confirm these results and inform clinical decision-making.