Sleep Apnea: Is Routine Preoperative Screening Necessary?
Abstract
Background Because perioperative complications of unrecognized obstructive sleep apnea (OSA) can be severe, many bariatric surgery programs routinely screen all patients. However, many obese non-bariatric surgery patients do not get screened. We wanted to evaluate the need for routine preoperative OSA screening.Methods Morbidly obese patients with a body mass index (BMI) > 40 kg/m(2) undergoing bariatric surgery--all screened for OSA--were compared to morbidly obese orthopedic lower extremity total joint replacements (TJR) patients--not screened for OSA. Cardio-pulmonary complications were recorded.Results Eight hundred eighty-two morbidly obese patients undergoing either bariatric (n = 467) or orthopedic TJR surgery (n = 415) were compared. As a result of screening, 119 bariatric surgery patients (25.5 %) were newly diagnosed with OSA, bringing the incidence to 42.8 % (200/467). Orthopedic surgery group had 72 of 415 (17.3 %) patients with pre-existing OSA. The unscreened orthopedic patients had a 6.7 % (23/343) cardiopulmonary complications rate compared to 2.6 % (7/267) for screened bariatric surgery patients. This difference was not statistically significant when adjusted for age and comorbidity (p = 0.3383).Conclusion Sleep apnea screening prior to bariatric surgery identifies an additional 25 % of patients as having OSA. In this study, unscreened morbidly obese patients did not have an increased incidence of cardiopulmonary complications after surgery compared to screened patients. Prospective randomized studies should be conducted to definitively assess utility and cost effectiveness of routine OSA screening of all morbidly obese patients undergoing surgery. Preoperative OSA screening may be safely omitted when randomizing patients for such a trial.
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Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69).
“Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69) or hypoxemia (WMD − 3.8%, 95% CI − 5.4% to − 2.2%) [45–59].”
Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain hypoxemia (WMD −3.8%, 95% CI −5.4% to −2.2%).
“Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69) or hypoxemia (WMD − 3.8%, 95% CI − 5.4% to − 2.2%) [45–59].”
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- Authors
- Nepomnayshy, D., Hesham, W., Erickson, B., MacDonald, J., Iorio, R., & Brams, D.
- Affiliations
- Tufts University (US)
- Corresponding author
- Nepomnayshy, Dmitry
- Venue
- Obesity Surgery
- Published
- 2012-10-27
- Volume
- 23
- Issue
- 3
- Pages
- 287-291
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- OpenAlex
- W2063137269
- Cited by
- 41
- References
- 23
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 7 · 2019: 8 · 2018: 1 · 2017: 3 · 2016: 4 · 2015: 4 · 2014: 3 · 2013: 2
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Obesity Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- obstructive sleep apnea, preoperative screening
- MeSH terms
- Female, Humans, Male, Mass Screening, Middle Aged, Obesity, Morbid, Postoperative Complications, Preoperative Care, Retrospective Studies, Severity of Illness Index, Gastroplasty, Body Mass Index, Risk Assessment, Patient Selection, Arthroplasty, Replacement, Sleep Apnea, Obstructive, Lower Extremity
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