Christel A L de Raaff1, Annouk S Pierik2, Usha K Coblijn3, Nico de Vries4,5,6, H Jaap Bonjer3, Bart A van Wagensveld2. 1. Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. c.deraaff@olvg.nl. 2. Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. 3. Department of Surgery, VU Medical Center, Amsterdam, The Netherlands. 4. Department of Otolaryngology, OLVG West, Amsterdam, The Netherlands. 5. Department of Oral Kinesiology, ACTA, Amsterdam, The Netherlands. 6. Department of Otolaryngology, Head and Neck Surgery, UZA, Antwerp, Belgium.
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.
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.
Authors: M J L Ravesloot; J P van Maanen; A A J Hilgevoord; B A van Wagensveld; N de Vries Journal: Eur Arch Otorhinolaryngol Date: 2012-02-05 Impact factor: 2.503
Authors: Sophie L van Veldhuisen; Kim Kuppens; Christel A L de Raaff; Marinus J Wiezer; Steve M M de Castro; Ruben N van Veen; Dingeman J Swank; Ahmet Demirkiran; Evert-Jan G Boerma; Jan-Willem M Greve; Francois M H van Dielen; Geert W J Frederix; Eric J Hazebroek Journal: BMJ Open Date: 2020-10-07 Impact factor: 2.692