Sleep Apnea: is Routine Preoperative Screening Necessary?

Overview

Journal Obes Surg

Date 2012 Oct 30

PMID 23104390

Citations 17

Authors

Dmitry Nepomnayshy

Walid Hesham

Brandon Erickson

Julie MacDonald

Richard Iorio

David Brams

Affiliations

Soon will be listed here.

Abstract

Background: Because perioperative complications of unrecognized obstructive sleep apnea (OSA) can be severe, many bariatric surgery programs routinely screen all patients. However, many obese non-bariatric surgery patients do not get screened. We wanted to evaluate the need for routine preoperative OSA screening.

Methods: Morbidly obese patients with a body mass index (BMI) > 40 kg/m(2) undergoing bariatric surgery--all screened for OSA--were compared to morbidly obese orthopedic lower extremity total joint replacements (TJR) patients--not screened for OSA. Cardio-pulmonary complications were recorded.

Results: Eight hundred eighty-two morbidly obese patients undergoing either bariatric (n = 467) or orthopedic TJR surgery (n = 415) were compared. As a result of screening, 119 bariatric surgery patients (25.5 %) were newly diagnosed with OSA, bringing the incidence to 42.8 % (200/467). Orthopedic surgery group had 72 of 415 (17.3 %) patients with pre-existing OSA. The unscreened orthopedic patients had a 6.7 % (23/343) cardiopulmonary complications rate compared to 2.6 % (7/267) for screened bariatric surgery patients. This difference was not statistically significant when adjusted for age and comorbidity (p = 0.3383).

Conclusion: Sleep apnea screening prior to bariatric surgery identifies an additional 25 % of patients as having OSA. In this study, unscreened morbidly obese patients did not have an increased incidence of cardiopulmonary complications after surgery compared to screened patients. Prospective randomized studies should be conducted to definitively assess utility and cost effectiveness of routine OSA screening of all morbidly obese patients undergoing surgery. Preoperative OSA screening may be safely omitted when randomizing patients for such a trial.

Citing Articles

Peri- and Postoperative Outcomes for Obstructive Sleep Apnoea Patients after Bariatric Surgery-a Systematic Review and Meta-analysis.

Katasani T, Holt G, Al-Khyatt W, Idris I Obes Surg. 2023; 33(7):2016-2024.

PMID: 37140722 PMC: 10289925. DOI: 10.1007/s11695-023-06557-8.

Enhanced recovery after bariatric surgery: an Italian consensus statement.

Marinari G, Foletto M, Nagliati C, Navarra G, Borrelli V, Bruni V Surg Endosc. 2022; 36(10):7171-7186.

PMID: 35953683 PMC: 9485178. DOI: 10.1007/s00464-022-09498-y.

Protocol of a multicentre, prospective cohort study that evaluates cost-effectiveness of two perioperative care strategies for potential obstructive sleep apnoea in morbidly obese patients undergoing bariatric surgery.

van Veldhuisen S, Kuppens K, de Raaff C, Wiezer M, de Castro S, van Veen R BMJ Open. 2020; 10(10):e038830.

PMID: 33033026 PMC: 7542938. DOI: 10.1136/bmjopen-2020-038830.

Validation of the GOAL Questionnaire as an Obstructive Sleep Apnea Screening Instrument in Bariatric Surgery Candidates: a Brazilian Single-Center Study.

Duarte R, Magalhaes-da-Silveira F, Gozal D Obes Surg. 2020; 30(12):4802-4809.

PMID: 32748204 DOI: 10.1007/s11695-020-04888-4.

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

Lorenzo N, Antoniou S, Batterham R, Busetto L, Godoroja D, Iossa A Surg Endosc. 2020; 34(6):2332-2358.

PMID: 32328827 PMC: 7214495. DOI: 10.1007/s00464-020-07555-y.

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