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Positional obstructive sleep apnea in bariatric surgery patients: risk factor for postoperative cardiopulmonary complications?

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Abstract

Background

Up to 80 % of the bariatric surgery (BS) patients suffer from obstructive sleep apnea (OSA). BS patients with moderate to severe OSA (apnea-hypopnea index (AHI) ≥15) are usually treated with continuous positive airway pressure (CPAP). This is not indicated in mild OSA patients (AHI <15). However, >50 % of patients with mild OSA have positional OSA (POSA); their AHI is at least twice as high in supine sleeping position than in other positions. Since many patients sleep in supine position for surgical safety reasons after BS, evaluating the AHI in this position might be more relevant in this group. The aim of this study is to evaluate the postoperative cardiopulmonary complication rate in mild OSA patients with and without POSA. Secondary aim is to evaluate predictive factors for POSA.

Methods

A single-institute retrospective analysis was achieved with all consecutive patients who underwent primary laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy between 2006 and 2014. All patients with an AHI between 5 and 15 were included. Postoperative complications were compared between POSA and non-POSA patients. Predictive factors were evaluated through univariate and multivariable logistic regression analysis.

Results

A total of 277 patients, 153 with and 124 without POSA, were included. After BS, three patients (1.1 %) experienced severe cardiopulmonary complications. No significant difference was found between POSA and non-POSA patients. In multivariate analysis, age and BMI were found to be negative predictors for POSA.

Conclusion

In terms of 30-day postoperative cardiopulmonary outcome, CPAP therapy is not indicated in mild (P)OSA patients scheduled for BS.

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Abbreviations

AHI:

Apnea-hypopnea index

BMI:

Body mass index

BS:

Bariatric surgery

CPAP:

Continuous positive airway pressure

LRYGB:

Laparoscopic Roux-en-Y gastric bypass

LSG:

Laparoscopic sleeve gastrectomy

OSA:

Obstructive sleep apnea

POSA:

Positional obstructive sleep apnea

PG:

Polygraphy

PSG:

Polysomnography

SLAZ:

Sint Lucas Andreas Hospital

% TST:

Percentage of total sleep time

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Acknowledgments

The authors would like to acknowledge Bart Torensma, clinical epidemiologist, for his assistance with statistical analysis.

Conflict of interest

All other authors declare that they have no conflict of interest.

Source of funding

Prof. de Vries is a member of the Medical Advisory Board of NightBalance and has shares in NightBalance.

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Authors and Affiliations

  1. Department of Surgery, St. Lucas Andreas Hospital, Amsterdam, The Netherlands

    Christel A. L. de Raaff, Dana M. Bindt & Bart A. van Wagensveld

  2. Department of Otolaryngology, St. Lucas Andreas Hospital, Amsterdam, The Netherlands

    Nico de Vries

  3. Department of Otolaryngology, University of Antwerp, Antwerpen, Belgium

    Nico de Vries

  4. Obesity Center Amsterdam, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    Christel A. L. de Raaff & Bart A. van Wagensveld

Authors
  1. Christel A. L. de Raaff
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  2. Dana M. Bindt
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  3. Nico de Vries
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  4. Bart A. van Wagensveld
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Corresponding author

Correspondence to Christel A. L. de Raaff.

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de Raaff, C.A.L., Bindt, D.M., de Vries, N. et al. Positional obstructive sleep apnea in bariatric surgery patients: risk factor for postoperative cardiopulmonary complications?. Sleep Breath 20, 113–119 (2016). https://doi.org/10.1007/s11325-015-1192-0

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  • DOI: https://doi.org/10.1007/s11325-015-1192-0

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