Does Obstructive Sleep Apnea (OSA) Increase the Risk of Post-Operative Respiratory Complications after Bariatric Surgery?

Abstract

Background: OSA affects up to quarter of general population. It is associated with morbid obesity with a higher morbidity and mortality rates. STOP Bang questionnaire is a validated method for OSA screening. OSA patients are at high risk of developing airway obstruction, cardiac events, congestive heart failure, stroke and desaturation post operatively. The aim of this study is to evaluate adverse respiratory events in patients undergoing bariatric surgery in relation to risk of OSA using Stop Bang questionnaire. Methods: This prospective double cohort study was conducted in Tanta University Hospital from Marchto August 2017. During the preoperative assessment, STOP-BANG questionnaire was performed. After extubation, patients were transferred to PACU unit. Respiratory complications were assessed thereafter. Based on STOP-BANG score, patients were divided into two groups, high risk of OSA with STOP-BANG > 3 (Group I) and low risk of OSA with STOP-BANG < 3 (Group II). Results: 104 patients were included in this study. Group I had more comorbidities in the form of CAD (15% versus 2%, P < 0.001), dyslipidemia (28% versus 11%, P < 0.001) and diabetes on insulin treatment (38% versus 6%, P > 0.001). Higher number of respiratory complications was noted in high-risk group (31 patients, 59%) compared to (24 patients, 46%) in group II yet, it was not significant. Conclusion: Obese patients with STOP-BANG score > 3 undergoing bariatric surgery are associated with hypertension, dyslipidemia, CAD, and renal insufficiency. High-risk OSA obese patients are at higher risk of developing respiratory compilations like inability to breathe deeply and hypoxia in postoperatively.

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

“…No observational evidence directly addressing the question was found. Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69) or hypoxemia (WMD − 3.8%, 95% CI − 5.4% to − 2.2%) [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. The latter outcome might not be clinically important, whereas the summary certainty in the evidence was very low due to risk of bias (non-controlled confounders in cohort studies), imprecision, statistical and conceptual heterogeneity (differences in definition of sleep apnea and method of diagnosis) (Supplementary Table 6).…”