Surgery for adult obstructive sleep apnoea

To the Editor: MacKay and Weaver’s article on otolaryngological procedures for obstructive sleep apnoea (OSA) provides an overview of various surgical procedures with a limited clinical evidence base.1 For an article titled Surgery for adult obstructive sleep apnoea, it leaves out the most evidence-based surgical option for OSA. While the authors have correctly acknowledged the role of weight loss in the management of OSA, there is no mention of the role of bariatric surgery in the treatment of OSA, despite two meta-analyses showing the efficacy of bariatric surgery in improving and resolving clinical and polysomnographic features of OSA in most of the patients studied.2,3 Given that the current obesity epidemic in the Western world is largely responsible for the rising prevalence in adult OSA,4 referral for surgical intervention in OSA patients with a body mass index of more than 30 kg/m2 should perhaps be first to a bariatric surgeon. This may well be the most cost-effective and holistic surgical option, as bariatric surgery is well recognised as being effective in resolving the other comorbid conditions associated with both OSA and obesity, namely hypertension, mood disturbances and fatigue.2,3