Abstract
Background
Obstructive sleep apnea (OSA), present in 60–70 % of bariatric surgery patients, is a potentially life-threatening condition when not detected and managed appropriately. The best available method to identify the severity of OSA is polysomnography. However, routine polysomnography measurements have not been accepted as standard modality in bariatric surgery. We report our experience with routine polysomnography in a cohort of patients undergoing bariatric surgery to determine the true prevalence of OSA with respect to the different severity levels as determined by the apnea–hypopnea index (AHI).
Methods
AHI data were retrospectively collected from all patients who underwent bariatric surgery from 2012 onward, when the performance of preoperative polysomnography became mandatory. Mild, moderate and severe OSA were defined as an AHI ≥5, ≥15 and ≥30/h, respectively. Prevalence and number needed to screen (NNS) were calculated for all OSA severity levels.
Results
A total of 1358 patients were included. OSA was detected in 813 (59.9 %; NNS: 2) patients. Moreover, 405 (29.8 %; NNS: 4) patients were diagnosed with an AHI ≥15/h and 213 (15.7 %; NNS: 7) with severe OSA (AHI ≥30/h). Extreme AHI thresholds of ≥60 and ≥90/h were detected in 79 (5.8 %; NNS: 18) and 17 (1.3 %; NNS: 77) patients, respectively.
Conclusion
One-third of the bariatric surgery patients have an AHI ≥15/h and would benefit from continuous positive airway pressure therapy. In order to increase perioperative safety and avoid the preventable risk of perioperative complications, we recommend mandatory P(S)G prior to bariatric surgery.
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Abbreviations
- AHI:
-
Apnea–hypopnea index
- BMI:
-
Body mass index
- CPAP:
-
Continuous positive airway pressure
- CV:
-
Cardiovascular
- IFSO:
-
International Federation for the Surgery of Obesity and Metabolic Disorders
- LRYGB:
-
Laparoscopic Roux-en-Y gastric bypass
- LSG:
-
Laparoscopic sleeve gastrectomy
- NNS:
-
Number needed to screen
- OSA:
-
Obstructive sleep apnea
- PG:
-
Polygraphy
- PSG:
-
Polysomnography
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Prof. Dr. N. de Vries is a member of the Medical Advisory Board of NightBalance and has shares in Nightbalance. Prof. Dr. H. J. Bonjer receives personal fees from Olympus and grants from Johnson & Johnson, Applied Medical and Medtronic. Drs. C. A. L. de Raaff, Ms. A. S. Pierik, Drs. U. K. Coblijn and Dr. B. A. van Wagensveld declare that they have no conflicts of interest of financial ties to disclose.
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de Raaff, C.A.L., Pierik, A.S., Coblijn, U.K. et al. Value of routine polysomnography in bariatric surgery. Surg Endosc 31, 245–248 (2017). https://doi.org/10.1007/s00464-016-4963-1
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DOI: https://doi.org/10.1007/s00464-016-4963-1