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Value of routine polysomnography in bariatric surgery

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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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Authors and Affiliations

  1. Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    Christel A. L. de Raaff, Annouk S. Pierik & Bart A. van Wagensveld

  2. Department of Surgery, VU Medical Center, Amsterdam, The Netherlands

    Usha K. Coblijn & H. Jaap Bonjer

  3. Department of Otolaryngology, OLVG West, Amsterdam, The Netherlands

    Nico de Vries

  4. Department of Oral Kinesiology, ACTA, Amsterdam, The Netherlands

    Nico de Vries

  5. Department of Otolaryngology, Head and Neck Surgery, UZA, Antwerp, Belgium

    Nico de Vries

Authors
  1. Christel A. L. de Raaff
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  2. Annouk S. Pierik
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  3. Usha K. Coblijn
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  4. Nico de Vries
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  5. H. Jaap Bonjer
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  6. Bart A. van Wagensveld
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Corresponding author

Correspondence to Christel A. L. de Raaff.

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Disclosures

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

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