Complications and predictors associated with moderate to severe obstructive sleep apnoea in bariatric surgery: Evaluation of routine obstructive sleep apnoea screening

L M G Nijland; S L van Veldhuisen; R N van Veen; E J Hazebroek; H J Bonjer; S M M de Castro

doi:10.1016/j.surge.2023.07.002

Complications and predictors associated with moderate to severe obstructive sleep apnoea in bariatric surgery: Evaluation of routine obstructive sleep apnoea screening

Surgeon. 2023 Dec;21(6):e361-e366. doi: 10.1016/j.surge.2023.07.002. Epub 2023 Aug 14.

Authors

L M G Nijland¹, S L van Veldhuisen², R N van Veen³, E J Hazebroek⁴, H J Bonjer⁵, S M M de Castro³

Affiliations

¹ Department of Surgery, OLVG West, Amsterdam, the Netherlands. Electronic address: l.m.g.nijland@olvg.nl.
² Department of Surgery/Vitalys Clinic, Rijnstate, Arnhem, the Netherlands.
³ Department of Surgery, OLVG West, Amsterdam, the Netherlands.
⁴ Department of Surgery/Vitalys Clinic, Rijnstate, Arnhem, the Netherlands; Wageningen University & Research, Human Nutrition & Health, the Netherlands.
⁵ Amsterdam UMC, VU, Amsterdam, the Netherlands.

PMID: 37587004
DOI: 10.1016/j.surge.2023.07.002

Abstract

Purpose: Obstructive sleep apnoea (OSA) is a breathing disorder resulting in blockage of airflow and hypo-oxygenation. The incidence of OSA in patients with class 2 or 3 obesity (Body Mass index, BMI >35) is 60-70%. Unfortunately, most bariatric patients are unaware they suffer from OSA. Untreated OSA can lead to perioperative cardiopulmonary complications. The aim of this study was to identify predictors associated with moderate to severe OSA and asses the incidence of OSA-related complications in a large cohort of patients who underwent OSA-screening and treatment if indicated before bariatric surgery.

Methods: All consecutive patients who underwent primary bariatric surgery between September 2013 and September 2019 were included. Univariable and multivariable logistic regression analysis was performed to identify potential predictors for moderate to severe OSA using sleep studies.

Results: A total of 2872 patients who underwent bariatric surgery were included for analysis. Overall, OSA was identified in 62.5% of all patients and moderate to severe OSA (AHI ≥15) in 28.6%. Independent predictors for moderate to severe OSA were male gender (p < 0.001), age (p < 0.001), preoperative BMI (p < 0.001), preoperative waist circumference (p < 0.001), hypertension (p < 0.001), and dyslipidaemia (p = 0.046). The incidence of OSA-related complications was low (0.8%) and not significantly different among the different OSA severity classes.

Conclusion: This is the largest study to assess OSA presence and OSA-related complications in patients undergoing bariatric surgery. The incidence of potential OSA-related complications was low (0.8%). We believe focus could be shifted towards more cost-efficient strategies where OSA screening is omitted such as perioperative continuous monitoring.

Keywords: Bariatric surgery; Complications; Obstructive sleep apnoea; Screening; Sleep study.

MeSH terms

Bariatric Surgery* / adverse effects
Body Mass Index
Female
Humans
Male
Obesity / complications
Obesity, Morbid* / complications
Obesity, Morbid* / surgery
Polysomnography
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / diagnosis
Sleep Apnea, Obstructive* / epidemiology