Best practice to investigate obstructive sleep apnoea in patients undergoing bariatric surgery – are routine sleep studies really indicated?

Ajay Gupta, MBBS, MS, MRCSEd, Tabitha Gana, John Finney, Katie Kirk, Jochen Seidel, Srinivasan Balchandra, MBBS, MS, MD, FRCSI, FRCS, GEN, SURG. Doncaster Royal Infirmary

Objective: The objective of this study was to find the prevalence of Obstructive  sleep apnoea (OSA) in patients undergoing bariatric surgery who are screened on the basis of their Epworth Sleepiness score (ESS) and do not routinely undergo polysomnography (PSG) and and to observe any increased incidence of perioperative complications in the patients who were not diagnosed to have OSA based on their low ESS scores.


Methods: Prospective data of 153 consecutive patients who underwent bariatric surgery at Doncaster Royal Infirmary from January 2013 to December 2014 was retrospectively analysed in the study.

The electronic medical records were abstracted for patient characteristic information, co-morbid conditions, type of surgery, ESS score, confirmation of sleep apnoea by PSG, pre operative and post operative Continuous Positive Airway Pressure (CPAP) device use, duration of stay in the hospital and perioperative and post-operative complications (resulting in change in normal post-operative management or delay in discharge). These included pulmonary complications (aspiration, suspected or definite pneumonia (needing antibiotics), requirement for CPAP or bi-level Positive airway pressure (BIPAP) in patients who did not use it before operation, postoperative tracheal reintubation, mechanical ventilatory support after discharge from the recovery room, and respiratory arrest), myocardial infarction, dysrhythmia, stroke, thromboembolic events, sepsis, and acute decline in renal function (from change in creatinine concentrations). Complications within the first 30 postoperative days including bleeding, wound dehiscence, anastomotic leak, wound infection, need for reoperation, hospital readmission, or death were also noted.

Results: 142 patients were included in the study. 11 patients were excluded as they were already diagnosed with OSA and were using CPAP machine. Roux-en-Y Gastric bypass was performed in 98 patients, sleeve gastrectomy in 26 patients and adjustable gastric band was placed in 18 patients. Median Epworth score for these patients was 5 (range: 0-20 and interquartile range from 3 to 9).

121 patients had ESS of below 10 and out of these two needed post operative CPAP. Out of 21 patients who had ESS of 11 or higher only 8 had sleep apnoea diagnosed on PSG.

There was no post-operative complication in very small number of patients with sleep apnoea (n=8). In the other 134 patients, 16 patients (11 %) had some form of post-operative complication. This included chest infections in 10 patients, new AF in 1, post-operative CPAP due to desaturation in 1 , UTI(urinary tract infection) in 1 infected band in 1, diverticulitis in 1 and wound infection in 1. 5 patients were readmitted; 3 with constipation, 1 with adhesional obstruction and 1 with diarrhoea and vomiting.

Median hospital stay for all patients was 3 days (range 1-9 days). The median hospital stay for the patients with OSA was 4 days and for patients without a diagnosed sleep apnoea was 3 days.


Conclusion: The complication rates in undiagnosed cases of OSA in bariatric patients were not found to be any higher suggesting that routine use of a resource consuming sleep studies in these patients as a pre anaesthetic assessment tool may not be necessary.


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