Combined Airway and Bariatric Surgery for Obesity Hypoventilation Syndrome: Feasibility and Early Outcomes-A Prospective Observational Cohort Study.

Background: Obesity hypoventilation syndrome (OHS) is a life-threatening condition often underdiagnosed in patients with obstructive sleep apnea (OSA). While bariatric surgery induces weight loss, it does not immediately resolve upper airway obstruction. We investigated the feasibility and clinical predictors of a novel transdisciplinary approach-Combined Airway and Bariatric Surgery (CABS)-in treating OHS. Methods: This prospective observational cohort study (December 2022-November 2024) recruited 36 adults with obesity (body mass index [BMI] ≥ 30 kg/m2) and OSA (apnea-hypopnea index [AHI] ≥ 5 events/h). OHS was diagnosed by daytime hypercapnia (PaCO2 ≥ 45 mmHg) after excluding other causes of hypoventilation. Participants received CABS or positive airway pressure therapy via shared decision-making. Primary outcomes included changes in AHI, BMI, PaCO2, and Epworth Sleepiness Scale (ESS). Results: Nine of 36 individuals (25%) had OHS. Multivariate logistic regression identified BMI and ESS as significant predictors. Receiver operating characteristic curve analysis showed high OHS prediction with BMI ≥ 35.5 kg/m2 (area under the curve [AUC] = 0.85), ESS ≥ 12 (AUC = 0.72), and a novel OHS prediction score > 20 (AUC = 0.94). Among 6 OHS patients who underwent CABS, one-year follow-up showed significant improvements: AHI decreased from 98.1 to 26.8 events/h, BMI from 40.1 to 29.1 kg/m2, and PaCO2 from 50.2 to 37.9 mmHg (all p < 0.05). Conclusions: OHS was present in one-quarter of individuals with obesity and OSA in this cohort. CABS was feasible and associated with encouraging improvements in sleep-disordered breathing, ventilatory status, and weight among selected patients. These preliminary findings support further evaluation of this transdisciplinary strategy in larger, comparative studies.