Obstructive Sleep Apnea in Patients Undergoing Bariatric Surgery—A Tertiary Center Experience

Abstract

The prevalence of OSA in all patients considered for bariatric surgery was greater than 77%, irrespective of OSA symptoms, gender, menopausal status, age, or BMI. The prediction model that we developed for the presence of OSA (AHI ≥ 5 events per hour) has excellent discriminative ability (evidenced by an AUC value of 0.8). However, the negative prediction values for the presence of OSA were too low to be clinically useful due to the high prevalence of OSA in this high-risk group. We demonstrated that, by utilizing even the most stringent possible cutoff values for the prediction model, OSA cannot be predicted with enough certainty. Therefore, we advocate routine PSG testing for all patients that are considered for bariatric surgery.

Assessment of Obstructive Sleep Apnea in Adults Undergoing Bariatric Surgery in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) Study

“…1 Although the reported prevalence of obstructive sleep apnea (OSA) in bariatric surgery patients has been highly variable (ranging from 41% to 98%), [2][3][4][5][6][7][8][9] it is clearly substantially higher than the 2% to 4% prevalence in the general adult population. 10,11 There is evidence to suggest that OSA is independently associated with increased risk of perioperative and postoperative complications, 12,13 including following bariatric surgery.…”

“…14,15 Thus, it has been argued that preoperative assessment and treatment of OSA is indicated in this population. 4,8 However, to date, neither the American Academy of Sleep Medicine or the American Society for Metabolic and Bariatric Surgery has published guidelines regarding screening, testing, or treatment for OSA prior to bariatric surgery.…”

“…However, perhaps the utility of the BQ could be improved in this population with an alternative scoring scheme, or if it was used in conjunction with participant characteristics, such as age, sex, BMI, and neck circumference, which are associated with OSA status and severity in bariatric surgery patients. 5,8,29,30 To address short comings in the literature, this study aimed to (1) determine the frequency of diagnostic testing for OSA in preparation for bariatric surgery in a large cohort of adults (n = 2,458) undergoing bariatric surgery at ten hospitals throughout the United States, (2) report the prevalence of OSA and PAP use among patients who did and did not undergo PSG in preparation for surgery, (3) determine whether BQ responses and scores (using traditional and alternative scoring algorithms) differ by OSA status and PAP use, and (4) determine factors independently related to confirmed OSA status.…”

Perioperative Complications in Obstructive Sleep Apnea Patients

“…Patients undergoing evaluation for bariatric surgery, often morbidly obese, represent a specific population of interest. Indeed, studies where PSG or HSAT were systematically completed in all patients have found prevalence rates of OSA to be 70-90 % [43][44][45][46], suggesting objective sleep testing should be part of the routine assessment prior to bariatric surgery.…”

Avaliação da faringe de pacientes portadores de apneia obstrutiva do sono, por meio da tomografia computadorizada multislice obtida em vigília e durante o sono

“…A faringe pode, ainda, ser dividida nas regiões retropalatal (RP) e retrolingual (RL), e esta divisão é especialmente utilizada em pacientes com SAOS (31) . A região RP está localizada posteriormente ao palato mole, do nível do palato duro até o nível da ponta da úvula.…”