Meta-Analysis of Risk Difference in Obstructive Sleep Apnea Before and After Endoscopic Sleeve Gastroplasty

Introduction: Percentage of weight gain is strongly correlated with risk of obstructive sleep apnea (OSA). Endoscopic sleeve gastroplasty (ESG) has emerged as an important technique to fill the gaps in obesity management amongst lifestyle changes, pharmacotherapy, and bariatric surgery. This is the first meta-analysis on the effects of ESG and improvement of OSA. Methods: This meta-analysis collated data from studies published from inception to 2023. PubMed Embase (embase.com) and Cochrane CENTRAL (via Ovid) were used to identify studies reporting data on OSA before and after ESG. A total of 1413 results were obtained, with 246 duplicates removed. Among these, 1167 studies were excluded as they did not report ESG and OSA outcomes, and 26 titles were screened via full texts. The final analysis incorporated data from 5 studies that supplied adequate information concerning ESG and OSA. The risk ratio was computed for each study, representing the risk of OSA following ESG. These ratios were pooled using a random-effects pairwise meta-analysis in STATA 16.1 to account for potential heterogeneity between studies, utilizing the DerSimonian-Laird method to estimate between-study variance. The standard errors of these ratios were calculated to assess the precision of the effect estimates. The extent of heterogeneity was quantified and reported using the I2 statistic, representing the percentage of total variation across studies due to heterogeneity rather than chance. All analyses were assisted by GPT-4 (Wolfram API). Results: ESG showed a significant improvement in OSA with an overall RR of 0.51 (95% CI [0.17, 0.86], P = 0.004) and moderate heterogeneity (I2 = 75.5%), implying that the risk of OSA could reduce by roughly half after ESG (Figure 1). The median TBWL at 3 months, reported by 3 studies, was 15.3%. At 6 months, the median TBWL was 16.6%, as reported by 5 studies. Six studies reported that by 12 months, the median TBWL was 16.98%. The mean % EWL at 3 months, as reported by the studies, was 44.08%. Based on the available data, the mean % EWL was 46.66% at 6 months; finally, at 12 months, the mean % EWL was 44.41%. The high heterogeneity (I2 = 75%) underscores the diverse outcomes across the studies. Further research is needed to elucidate the factors contributing to this variability. Conclusion: ESG is an effective method for weight loss and to reduce risk of obesity-related OSA. Given currently limited studies, larger and more prospective analysis will need to be conducted.Figure 1.: Forest Plot of 5 Studies.