Peri-operative treatment of sleep-disordered breathing and outcomes in bariatric patients
Open accessAbstract
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Meta-analysis of observational studies suggested higher odds of postoperative pneumonia (OR 0.24, 95% CI 0.07 to 0.82) with perioperative CPAP.
“Meta-analysis of observational studies suggested higher odds of postoperative pneumonia (OR 0.24, 95% CI 0.07 to 0.82), a trend towards lower odds of reintubation (OR 0.28, 95% CI 0.07 to 1.04), and shorter hospital stay (WMD − 1.6 days, 95% CI − 1.83 to − 1.28) albeit relevant evidence was of low certainty due to imprecision and the observational study design (Supplementary Table S7) [51, 52, 60,”
Meta-analysis of observational studies suggested a trend towards lower odds of reintubation with perioperative CPAP (OR 0.28, 95% CI 0.07 to 1.04).
“Meta-analysis of observational studies suggested higher odds of postoperative pneumonia (OR 0.24, 95% CI 0.07 to 0.82), a trend towards lower odds of reintubation (OR 0.28, 95% CI 0.07 to 1.04), and shorter hospital stay (WMD − 1.6 days, 95% CI − 1.83 to − 1.28) albeit relevant evidence was of low certainty due to imprecision and the observational study design (Supplementary Table S7) [51, 52, 60,”
Meta-analysis of observational studies suggested shorter hospital stay with perioperative CPAP (WMD −1.6 days, 95% CI −1.83 to −1.28).
“Meta-analysis of observational studies suggested higher odds of postoperative pneumonia (OR 0.24, 95% CI 0.07 to 0.82), a trend towards lower odds of reintubation (OR 0.28, 95% CI 0.07 to 1.04), and shorter hospital stay (WMD − 1.6 days, 95% CI − 1.83 to − 1.28) albeit relevant evidence was of low certainty due to imprecision and the observational study design (Supplementary Table S7) [51, 52, 60,”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale
Johns, M. W. (1991) · Sleep · doi:10.1093/sleep/14.6.540 · Cited by 17,364 · see citing works
The validity of the Hospital Anxiety and Depression Scale
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(01)00296-3 · Cited by 9,779 · cited 1× · see citing works
“com changes in sleep may be symptoms of these disorders (14).”
BackgroundSTOP Questionnaire: A Tool to Screen Patients for Obstructive Sleep Apnea
Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., Vairavanathan, S., Islam, S., Khajehdehi, A., & Shapiro, C. M. (2008) · Anesthesiology · doi:10.1097/aln.0b013e31816d83e4 · Cited by 2,355 · see citing works
Day–Night Pattern of Sudden Death in Obstructive Sleep Apnea
Gami, A. S., Howard, D. E., Olson, E. J., & Somers, V. K. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa041832 · Cited by 1,032 · see citing works
Continuous positive airways pressure for obstructive sleep apnoea in adults
Giles, T., Lasserson, T., Smith, B., White, J., Wright, J., & Cates, C. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001106.pub2 · Cited by 1,001 · see citing works
McNicholas, W. T., Bonsignore, M. R., & the Management Committee of EU COST ACTION B26 (2007) · European Respiratory Journal · doi:10.1183/09031936.00027406 · Cited by 911 · see citing works
Qaseem, A., Snow, V. T., Fitterman, N., Hornbake, E. R., Lawrence, V. A., Smetana, G. W., Weiss, K. B., & Owens, D. K. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-8-200604180-00008 · Cited by 685 · see citing works
Nagappa, M., Liao, P., Wong, J., Auckley, D., Ramachandran, S. K., Memtsoudis, S., Mokhlesi, B., & Chung, F. (2015) · PLOS ONE · doi:10.1371/journal.pone.0143697 · Cited by 684 · see citing works
Preoperative Pulmonary Evaluation
Smetana, G. W. (1999) · New England Journal of Medicine · doi:10.1056/nejm199903253401207 · Cited by 555 · see citing works
Doherty, L. S., Kiely, J. L., Swan, V., & McNicholas, W. T. (2005) · Chest · doi:10.1378/chest.127.6.2076 · Cited by 485 · see citing works
Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome
Kaw, R., Chung, F., Pasupuleti, V., Mehta, J., Gay, P. C., & Hernandez, A. V. (2012) · British Journal of Anaesthesia · doi:10.1093/bja/aes308 · Cited by 449 · see citing works
Continuous positive airways pressure for obstructive sleep apnoea in adults
Giles, T., Lasserson, T., Smith, B. J., White, J., Wright, J., & Cates, C. J. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001106.pub3 · Cited by 383 · see citing works
Obesity and respiratory diseases
Makker, H. K. (2010) · International Journal of General Medicine · doi:10.2147/ijgm.s11926 · Cited by 362 · see citing works
Ferini‐Strambi, L., Baietto, C., Gioia, M. R., Castaldi, P. J., Castronovo, C., Zucconi, M., & Cappa, S. F. (2003) · Brain Research Bulletin · doi:10.1016/s0361-9230(03)00068-6 · Cited by 353 · see citing works
Peri‐operative management of the obese surgical patient 2015
Party:, M. O. T. W., Nightingale, C. E., Margarson, M., Shearer, E., Redman, J., Lucas, D. N., Cousins, J., Fox, W. T. A., Kennedy, N. J., Venn, P. J. H., et al. (2015) · Anaesthesia · doi:10.1111/anae.13101 · Cited by 349 · see citing works
Kheterpal, S., Healy, D. W., Aziz, M. F., Shanks, A. M., Freundlich, R. E., Linton, F., Martin, L. D., Linton, J., Epps, J. L., Fernandez-Bustamante, A., et al. (2013) · Anesthesiology · doi:10.1097/aln.0000435832.39353.20 · Cited by 337 · see citing works
STOP Questionnaire: A Tool to Screen Patients for Obstructive Sleep Apnea
Jones, S. (2009) · Yearbook of Pulmonary Disease · doi:10.1016/s8756-3452(08)79244-2 · Cited by 309 · see citing works
Lopez, P. P., Stefan, B., Schulman, C. I., & Byers, P. M. (2008) · The American Surgeon™ · doi:10.1177/000313480807400914 · Cited by 261 · see citing works
Chai‐Coetzer, C. L., Luo, Y., Antic, N. A., Zhang, X., Chen, B.-Y., He, Q.-Y., Heeley, E. L., Huang, S., Anderson, C. S., Zhong, N., et al. (2013) · SLEEP · doi:10.5665/sleep.3232 · Cited by 245 · see citing works
Evidence Supporting Routine Polysomnography Before Bariatric Surgery
O'Keeffe, T., & Patterson, E. J. (2004) · Obesity Surgery · doi:10.1381/096089204772787248 · Cited by 241 · see citing works
A Matched Cohort Study of Postoperative Outcomes in Obstructive Sleep Apnea
Mutter, T. C., Chateau, D. G., MOFFATT, M. E. K., Ramsey, C. D., Roos, L. L., & Kryger, M. H. (2014) · Anesthesiology · doi:10.1097/aln.0000000000000407 · Cited by 236 · see citing works
Opperer, M., Cozowicz, C., Bugada, D., Mokhlesi, B., Kaw, R., Auckley, D., Chung, F., & Memtsoudis, S. G. (2016) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000001178 · Cited by 219 · see citing works
Excessive daytime sleepiness in sleep disorders.
Slater, G., & Steier, J. S. (2012) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2072-1439.2012.10.07 · Cited by 205 · see citing works
Self-citationNeural respiratory drive in obesity
Steier, J. S., Jolley, C. J., Seymour, J., Roughton, M., Polkey, M. I., & Moxham, J. (2009) · Thorax · doi:10.1136/thx.2008.109728 · Cited by 203 · see citing works
Self-citationEffect of CPAP on Cognition, Brain Function, and Structure Among Elderly Patients With OSA
Dalmases, M., Solé‐Padullés, C., Torres, M., Embid, C., Núñez, M. D. S., Martínez‐García, M. Á., Farré, R., Bargalló, N., David Bartrés-faz, A., & Montserrat, J. M. (2015) · CHEST Journal · doi:10.1378/chest.15-0171 · Cited by 153 · see citing works
Postoperative complications in patients with obstructive sleep apnea: a meta-analysis
Hai, F., Porhomayon, J., Vermont, L., Frydrych, L., Jaoude, P., & El-Solh, A. A. (2014) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2014.05.010 · Cited by 139 · see citing works
Risk Assessment of Obstructive Sleep Apnea in a Population of Patients Undergoing Ambulatory Surgery
Stierer, T. L., Wright, C., George, A., Thompson, R. E., Wu, C. L., & Collop, N. A. (2010) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27936 · Cited by 132 · see citing works
CPAP in the Perioperative Setting
Chung, F. F., Nagappa, M., Singh, M., & Mokhlesi, B. (2015) · CHEST Journal · doi:10.1378/chest.15-1777 · Cited by 74 · see citing works
Obesity as an independent predictor of subjective excessive daytime sleepiness
Slater, G., Pengo, M. F., Kosky, C. A., & Steier, J. S. (2012) · Respiratory Medicine · doi:10.1016/j.rmed.2012.10.013 · Cited by 59 · see citing works
Self-citationKhilnani, G., Banga, A., & Sharma, S. K. (2004) · BMC Pulmonary Medicine · doi:10.1186/1471-2466-4-12 · Cited by 57 · see citing works
Evaluation of Sham-CPAP as a Placebo in CPAP Intervention Studies
Rodway, G. W., Weaver, T. E., Mancini, C., Cater, J. R., Maislin, G., Staley, B. A., Ferguson, K. A., George, C. F., Schulman, D. A., Greenberg, H. E., et al. (2010) · SLEEP · doi:10.1093/sleep/33.2.260 · Cited by 55 · see citing works
Steier, J. S., Martin, A., Harris, J., Jarrold, I., Pugh, D., & Williams, A. J. (2013) · Thorax · doi:10.1136/thoraxjnl-2013-203887 · Cited by 53 · see citing works
Self-citationIncreased load on the respiratory muscles in obstructive sleep apnea
Steier, J. S., Jolley, C. J., Seymour, J. M., Ward, K., Luo, Y. M., Polkey, M. I., & Moxham, J. (2010) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2010.01.012 · Cited by 38 · see citing works
Self-citationScreening for sleep-disordered breathing in a bariatric population.
Reed, K. I., Pengo, M. F., & Steier, J. S. (2016) · PubMed Central · doi:10.3978/j.issn.2072-1439.2015.11.58 · Cited by 38 · see citing works
Self-citationKuklisova, Z., Tkáčová, R., Joppa, P., Wouters, E. F. �., & Sastry, M. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.02.012 · Cited by 30 · see citing works
Screening for sleep-disordered breathing in a bariatric population
Reed, K. I., Pengo, M. F., & Steier, J. S. (2015) · doi:10.1183/13993003.congress-2015.pa2354 · Cited by 29 · see citing works
Self-citationRupprecht, S., Schultze, T., Nachtmann, A., Rastan, A. J., Doenst, T., Schwab, M. G., Witte, O. W., Rohe, S., Zwacka, I., & Hoyer, H. (2017) · European Respiratory Journal · doi:10.1183/13993003.01486-2016 · Cited by 26 · see citing works
Preoperative pulmonary evaluation
Jackson, C. V. (1988) · Archives of Internal Medicine · doi:10.1001/archinte.148.10.2120 · Cited by 23 · see citing works
Management of hypoxaemic respiratory failure in a Respiratory High‐dependency Unit
Hukins, C., Wong, M., Murphy, M., & Upham, J. W. (2017) · Internal Medicine Journal · doi:10.1111/imj.13403 · Cited by 10 · see citing works
Pengo, M. F., Drakatos, P., Kosky, C. A., Williams, A. J., Hart, N., Rossi, G. P., & Steier, J. S. (2014) · PubMed Central · doi:10.3978/j.issn.2072-1439.2014.05.09 · Cited by 9 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 2
- [1]1. McPherson K, Marsh T, Brown M (2013), Tackling obesities: future choicesmodelling future trends in obesity and the impact on health . 2nd Edition. Foresight, 2007.
- [9]9. Steier J, Kent B, (2016) Assessment and treatment of sleep-disordered breathing in the morbidly obese surgical patient , Cambridge University Press, September 2016
Cited by
Sorted by citations
Di Lorenzo, N., Antoniou, S. A., Batterham, R. L., Busetto, L., Godoroja, D., Iossa, A., Carrano, F. M., Agresta, F., Alarçon, I., Azran, C., et al. (2020) · Surgical Endoscopy · doi:10.1007/s00464-020-07555-y · Cited by 465 · see citing works
ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery
Carter, J., Chang, J., Birriel, T. J., Moustarah, F., Sogg, S., Goodpaster, K., Benson-Davies, S., Chapmon, K., & Eisenberg, D. (2021) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2021.08.024 · Cited by 86 · see citing works
- Authors
- Meurgey, J.-H., Brown, R., Woroszyl-Chrusciel, A., & Steier, J.
- Affiliations
- King's College London (GB)
- St Thomas' Hospital (GB)
- Corresponding author
- Steier, Joerg
- Venue
- Journal of Thoracic Disease
- Publisher
- AME Publishing Company
- Published
- 2018-01
- Volume
- 10
- Issue
- S1
- Pages
- S144-S152
- ISSN
- 2072-1439 (ISSN-L)
- 2077-6624
- PMC
- PMC5803041
- OpenAlex
- W2781815471
- Cited by
- 19
- References
- 40
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 2 · 2018: 2
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of Thoracic Disease (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- Funders
- National Institute for Health and Care Research
- King's College London
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- obstructive sleep apnea, bariatric surgery, continuous positive airway pressure, respiratory complications, STOP-BANG questionnaire, Epworth Sleepiness Scale, nocturnal oximetry
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
