The Metabolic Outcomes of Obstructive Sleep Apnea Surgery: A Scoping Review

To evaluate the available evidence on the metabolic outcomes of obstructive sleep apnea (OSA) surgery and identify gaps in the current literature.

A literature search was performed using PubMed, Embase, Web of Science, and Cochrane Library databases.

Search strategy was developed with a senior informationist at our institution. Metabolic measures of interest included insulin resistance, fasting glucose, hemoglobin A1C (HbA1c), inflammatory markers, adipokines, lipid profiles, and body mass index (BMI). Title, abstract, and full-text screening were performed by three reviewers with subsequent narrative synthesis.

3484 studies were initially identified, with 160 meeting inclusion criteria. 129 studies were included solely due to reporting of pre- and post-operative BMIs. The remaining 31 studies (n = 1675 participants) examined other metabolic outcomes and included various categories of OSA surgery: soft tissue surgery alone (58.1%) or in combination with nasal or skeletal surgery (32.3%), upper airway stimulation (6.5%), and skeletal surgery alone (3.2%). Within the 31 studies, the most commonly examined metabolic outcomes were C-reactive protein (CRP, 45.1%), lipid profiles (45.1%), TNF-α and IL-6 (25.8%), fasting glucose (25.8%), leptin (22.6%), HbA1c (19.4%), and insulin resistance (16.1%). Most studies demonstrated improvements in CRP, TNF-α, IL-6, and leptin, but no changes in fasting glucose, insulin resistance, or HbA1c. None of the included studies examined BMI as a primary outcome.

The existing literature suggests that OSA surgery is associated with improvements in inflammatory markers. The paucity of studies on the metabolic outcomes of upper airway stimulation and skeletal surgery highlights knowledge gaps for these OSA surgeries.