In patients undergoing surgical interventions under general anesthesia, obstructive sleep apnea syndrome (OSA) can cause serious perioperative cardiovascular or respiratory complications leading to fatal consequences, even sudden death. In this study we test the hypothesis that morbidly obese patients diagnosed by a polysomnography test and using continuous positive airway pressure (CPAP) therapy have fewer and less severe perioperative complications and a shorter hospital stay than patients who have a medical history that meets at least three STOP-Bang criteria and are not using CPAP therapy.
Postoperative hospital stay and pulmonary complications were analyzed in three groups of morbidly obese patients undergoing bariatric surgery (Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy) between January 2009 and November 2013 (n = 693). Group A comprised 99 patients who were preoperatively diagnosed with OSA based on polysomnography results. These patients used CPAP therapy before and after surgery. Group B consisted of 182 patients who met at least three STOP-Bang criteria but who were not diagnosed with OSA based on polysomnography results. These patients did not use CPAP. Group C, the reference group, comprised 412 patients who scored one to two items on the STOP-Bang.
During the perioperative period, Group B patients had a significantly (p < 0.001) higher cumulative rate of pulmonary complications, worse oxygen saturation, respiratory rates, and increased length of stay in hospital. There was also two cases of sudden death in this group.
Based on these results, we conclude that patients meeting at least three STOP-BANG criteria have higher postoperative complications and an increased length of hospital stay than patients using CPAP.
Weingarten TN, Flores AS, McKenzie JA, Nguyen LT, Robinson WB, Kinney TM, Siems BT, Wenzel PJ, Sarr MG, Marienau MS, Schroeder DR, Olson EJ, Morgenthaler TI, Warner DO, Sprung J. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth. 2011;106(1):131–9. PubMedCrossRef
Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263. PubMed
Bakker JP, Balachandran JS, Tecilazich F, Deyoung PN, Smales E, Veves A, Malhotra A. Pilot study of the effects of bariatric surgery and continuous positive airway pressure treatment on vascular function in obese subjects with obstructive sleep apnoea. Intern Med J. 2013;43(9):993–8. doi: 10.1111/imj.12224. PubMedCentralPubMedCrossRef
van Zeller M, Severo M, Santos AC, Drummond M. 5-Years APAP adherence in OSA patients—Do first impressions matter? Respir Med. 2013.107(12):2046–52.
http://www.ifso.com. Assessed on 7 Apr 2014.
Deutsch PA, Simmons MS, Wallace JM. Cost-effectiveness of split-night polysomnography and home studies in the evaluation of obstructive sleep apnea syndrome. J Clin Sleep Med. 2006;2(2):145–53. PubMed
de Quelerij M, van Velzen C, Luitwieler R, Meijer N, Gadiot RPM, van der Voet J, van der Klooster J, de Feiter PW, Mannaerts G, Verbrugge SJC. Prevalence and determinants of complications in a bariatric ICU population. NTVA. 2012;12(25):16–21.
- STOP-Bang and the effect on patient outcome and length of hospital stay when patients are not using continuous positive airway pressure
Monika A. Proczko
Pieter S. Stepaniak
Marcel de Quelerij
Floor Haak van der Lely
J. (Frans) Smulders
Mohammed A. Soliman Hamad
- Springer Japan
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