Obesity Surgery

, Volume 26, Issue 7, pp 1384–1390 | Cite as

Prevalence of Obstructive Sleep Apnoea Among Patients Admitted for Bariatric Surgery. A Prospective Multicentre Trial

  • P. Peromaa-HaavistoEmail author
  • H. Tuomilehto
  • J. Kössi
  • J. Virtanen
  • M. Luostarinen
  • J. Pihlajamäki
  • P. Käkelä
  • M. Victorzon
Original Contributions



Obesity has become one of the greatest public health concerns worldwide and is known to be the most important risk factor for obstructive sleep apnoea (OSA). Prevalence of OSA has increased over the last two decades, but it is estimated that the majority of cases still remain undiagnosed. The aim of this study was to investigate the prevalence of OSA in Finnish bariatric surgery candidates.


In this prospective multicentre study, standard overnight cardiorespiratory recording was conducted in 197 consecutive patients from three different hospitals. A sleep questionnaire was also administered. Anthropometric and demographic measurements included age, weight, body mass index (BMI) and waist and neck circumference.


Altogether, 71 % of the patients were diagnosed with OSA. The prevalence was higher in males (90 %) than in females (60 %) (p < 0.001). In OSA patients’ group, the mean neck and waist circumference was larger (p < 0.001) and the body weight higher (p < 0.01) than in non-OSA group. When separating patients by gender, a significant difference remained only concerning neck circumference in female patients.


OSA is very common among bariatric surgery patients, especially in men. Considering this and the increased long-term morbidity and mortality generally related to OSA, a routine screening for OSA seems indicated in bariatric patients, particularly men.


Bariatric surgery Obstructive sleep apnoea Prevalence Obesity surgery Metabolic surgery OSA 



The authors cordially acknowledge Miia Artama, PhD, for her critical assistance with statistical analysis; Jaana Elberkennou, MD, MA, for her kind revision of the English language and the clinical research nurses Synnöve Liukku, Helinä Mäkipää, Taina Poutiainen, Matti Laitinen and Marjo Soini.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    World Health Organization. Obesity and Overweight Fact Sheet N8311. 2006. Available from:
  2. 2.
    World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. 2007. Available from:
  3. 3.
    Tuomilehto H, Peltonen M, Partinen M, et al. Sleep-disordered breathing is related to an increased risk for type 2 diabetes in middle-aged men, but not in women—the FIN D2D-survey. Diabetes Obes Metab. 2008;10(6):468–75.CrossRefPubMedGoogle Scholar
  4. 4.
    Tasali E, Mokhlesi B, Van Cauter E. Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest. 2008;133:496–506.CrossRefPubMedGoogle Scholar
  5. 5.
    Punjabi N, Caffo B, Goodwin J, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6:e1000132.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Muraja-Murro A, Eskola K, Kolari T, et al. Mortality in middle-aged men with obstructive sleep apnea in Finland. Sleep Breath. 2013;17(3):1047–53.CrossRefPubMedGoogle Scholar
  7. 7.
    Pack A, Gislason T. Obstructive sleep apnea and cardiovascular disease: a perspective and future directions. Prog Cardiovasc Dis. 2009;51(5):434–51. Review.CrossRefPubMedGoogle Scholar
  8. 8.
    Tuomilehto H, Seppä J, Uusitupa M. Obesity and obstructive sleep apnea—clinical significance of weight loss. Sleep Med Rev. 2013;17:321–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Ashrafian H, le Roux C, Rowland S, et al. Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures. Thorax. 2012;67:442–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Peiser J, Lavie P, Ovnat A, et al. Sleep apnea syndrome in the morbidly obese as an indication for weight reduction surgery. Ann Surg. 1984;199:112–5.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Charuzi I, Lavie P, Peiser J, et al. Bariatric surgery in morbidly obese sleep-apnea patients: short- and long-term follow-up. Am J Clin Nutr. 1992;55:594S–6.PubMedGoogle Scholar
  12. 12.
    Haines K, Nelson L, Gonzales R, et al. Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea. Surgery. 2007;141:354–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Lettieri C, Eliasson A, Greenburg D. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med. 2008;4:333–8.PubMedPubMedCentralGoogle Scholar
  14. 14.
    American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22:667–89.Google Scholar
  15. 15.
    Carneiro G, Flório R, Zanella M, et al. Is mandatory screening for obstructive sleep apnea with polysomnography in all severely obese patients indicated? Sleep Breath. 2012;16:163–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Sareli A, Cantor C, Williams N, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary center experience. Obes Surg. 2011;21:316–27.CrossRefPubMedGoogle Scholar
  17. 17.
    Aguiar I, Freitas Jr W, Santos I, et al. Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial. Multidiscip Respir Med. 2014;9:43.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Sharkey K, Machan J, Tosi C, et al. Predicting obstructive sleep apnea among women candidates for bariatric surgery. J Women’s Health (Larchmt). 2010;19:1833–41.CrossRefGoogle Scholar
  19. 19.
    Kolotkin R, LaMonte M, Walker J, et al. Predicting sleep apnea in bariatric surgery patients. Surg Obes Relat Dis. 2011;7:605–10.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Valencia-Flores M, Orea A, Herrera M, et al. Effect of bariatric surgery on obstructive sleep apnea and hypopnea syndrome, electrocardiogram, and pulmonary arterial pressure. Obes Surg. 2004;14:755–62.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee Y, Johan A, Wong K, et al. Prevalence and risk factors for obstructive sleep apnea in a multiethnic population of patients presenting for bariatric surgery in Singapore. Sleep Med. 2009;10:226–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Koeck E, Barefoot L, Hamrick M, et al. Predicting sleep apnea in morbidly obese adolescents undergoing bariatric surgery. Surg Endosc. 2014;28:1146–52.CrossRefPubMedGoogle Scholar
  23. 23.
    Dixon J, Schachter L, O’Brien P. Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Chest. 2003;123:1134–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg. 2013;23(12):2050–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Toshniwal G, McKelvey GM, Wang H. STOP-Bang and prediction of difficult airway in obese patients. J Clin Anesth. 2014;26(5):360–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Proczko M, Stepaniak P, de Quelerij M, et al. STOP-Bang and the effect on patient outcome and length of hospital stay when patients are not using continuous positive airway pressure. J Anesth. 2014;28(6):891–7.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Nepomnayshy D, Hesham W, Erickson B, et al. Sleep apnea: is routine preoperative screening necessary? Obes Surg. 2013;23:287–91.CrossRefPubMedGoogle Scholar
  28. 28.
    Weingarten T, Flores A, McKenzie J, et al. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth. 2011;106(1):131–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Meoli A, Rosen C, Kristo D, et al. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period—avoiding complications. Sleep. 2003;26:1060–5.PubMedGoogle Scholar
  30. 30.
    Hwang D, Shakir N, Limann B, et al. Association of sleep-disordered breathing with postoperative complications. Chest. 2008;133:1128–34.CrossRefPubMedGoogle Scholar
  31. 31.
    Aminian A, Brethauser S, Kirwan J, et al. How safe is metabolic/diabetes surgery? Diabetes Obes Metab. 2015;17(2):198–201.CrossRefPubMedGoogle Scholar
  32. 32.
    Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32.CrossRefPubMedGoogle Scholar
  33. 33.
    Collop N, Anderson W, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med. 2007;3:737–47.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • P. Peromaa-Haavisto
    • 1
    Email author
  • H. Tuomilehto
    • 2
    • 3
    • 9
  • J. Kössi
    • 4
    • 8
  • J. Virtanen
    • 5
  • M. Luostarinen
    • 5
  • J. Pihlajamäki
    • 3
  • P. Käkelä
    • 6
  • M. Victorzon
    • 7
    • 8
  1. 1.Department of SurgeryHatanpää City HospitalTampereFinland
  2. 2.Oivauni Sleep ClinicKuopioFinland
  3. 3.Department of Clinical Nutrition, Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
  4. 4.Kantahäme Central HospitalHämeenlinnaFinland
  5. 5.Lahti Region Central HospitalLahtiFinland
  6. 6.Clinical Nutrition and Obesity CenterKuopio University HospitalKuopioFinland
  7. 7.Vaasa Central HospitalVaasaFinland
  8. 8.University of TurkuTurkuFinland
  9. 9.Oivauni Sleep ClinicTampereFinland

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