Peri-operative treatment of sleep-disordered breathing and outcomes in bariatric patients

Obstructive sleep apnoea (OSA) is increasingly common in bariatric patients undergoing sedation during elective surgery. However, it has not been established how significant a contributor it is to peri-operative respiratory complications and mortality. We sought to pre-operatively identify OSA in bariatric patients and record peri-operative complications during and after bariatric surgery.

Data were collected and analysed from June 2014 to March 2017 for 410 bariatric surgery patients referred to the sleep laboratory for pre-operative screening and treatment of OSA. The STOP-Bang questionnaire, Epworth Sleepiness Scale (ESS) and nocturnal pulse oximetry were recorded and treatment was allocated with continuous positive airway pressure (CPAP). Peri-operative complications and mortality were the primary outcome measures for patients receiving CPAP treatment for OSA, with patients who did not require CPAP used as control. The mean follow-up time for all patients was 433 and 732 days for the patients who had undergone bariatric surgery. The two groups were compared with Chi square test and unpaired two-tailed t-test.

OSA was present in any form in 70% of the screened patients; 40% of patients involved in the study received CPAP treatment. Patients receiving CPAP treatment [49.5 (11.3) years old, 61% female, 50.3 (8.5) kg/m²] were older, had a lower percentage of females and had a higher body mass index (BMI) than those not receiving CPAP [44.9 (12.0), 81% female, 46.6 (7.7)]. No significant differences were observed between patients on CPAP and those not on CPAP, there was no significant difference in hospital stay or rate of respiratory complications. Out of 53 patients who had undergone bariatric surgery at the cut-off date, only 1 had suffered a respiratory complication.

Bariatric patients who are screened pre-operatively for OSA and treated according to guidelines have no increased risk of respiratory complications compared to patients without OSA.