دورية أكاديمية

Polysomnography in pre-operative screening for obstructive sleep apnea in patients undergoing bariatric surgery: a retrospective cohort study.

التفاصيل البيبلوغرافية
العنوان: Polysomnography in pre-operative screening for obstructive sleep apnea in patients undergoing bariatric surgery: a retrospective cohort study.
المؤلفون: de Carvalho TR; Post-graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil. taisercarvalho@gmail.com., Blume CA; Post-graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Alessi J; Post-graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Schaan BD; Post-graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.; Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Telo GH; Post-graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
المصدر: International journal of obesity (2005) [Int J Obes (Lond)] 2022 Apr; Vol. 46 (4), pp. 802-808. Date of Electronic Publication: 2022 Jan 04.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Nature Pub. Group Country of Publication: England NLM ID: 101256108 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1476-5497 (Electronic) Linking ISSN: 03070565 NLM ISO Abbreviation: Int J Obes (Lond) Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : Nature Pub. Group, c2005-
مواضيع طبية MeSH: Bariatric Surgery*/adverse effects , Sleep Apnea, Obstructive*/complications, Adult ; Humans ; Polysomnography/adverse effects ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Retrospective Studies
مستخلص: Background/objectives: To assess the impact of obstructive sleep apnea (OSA) screening with polysomnography on preventing cardiovascular and pulmonary complications in the postoperative period of bariatric surgery.
Subjects/methods: This was a single-center retrospective cohort study, including 522 adults who underwent bariatric surgery between August 2010 and May 2019. Electronic medical records were accessed to obtain variables of interest. Screening for OSA was performed as a medical indication and registered as positive if apnea-hypopnea index was ≥5 events/hour in patients who did not have previous OSA diagnosis. The primary outcome was the presence of cardiac or pulmonary events in the 30-day postoperative period. Secondary outcomes included length of stay (days), need for an intensive care unit (ICU) after surgery, length of mechanical ventilation, and time from mechanical ventilation withdrawal. Statistical analyses were performed with χ 2 , Fisher's exact test, Student's t-test, Mann-Whitney U test, and Poisson regression.
Results: Most participants (n = 326) did not have OSA screening with polysomnography, while 196 had performed this screening. There was no difference in cardiopulmonary events between the screening and non-screening groups (4.2% vs. 2.8%; P = 0.45). Polysomnography screening could not reduce cardiovascular or pulmonary complications in the postoperative period, RR = 1.73 (95% CI: 0.68-4.14). There was no difference in ICU admission, length of stay, and time from mechanical ventilation between groups in secondary outcomes.
Conclusions: Our study suggests that OSA screening with polysomnography in the pre-operative care of bariatric surgery is a dispensable procedure, as it does not change postoperative cardiopulmonary outcomes. Indications for polysomnography should be made at the individual level.
(© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)
References: Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea: a review. JAMA. 2020;323:1389–400. (PMID: 10.1001/jama.2020.3514)
Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010;90:47–112. (PMID: 10.1152/physrev.00043.2008)
Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7:687–98. (PMID: 10.1016/S2213-2600(19)30198-5)
Garvey JF, Pengo MF, Drakatos P, Kent BD. Epidemiological aspects of obstructive sleep apnea. J Thorac Dis. 2015;7:920–9. (PMID: 261016504454867)
Jehan S, Zizi F, Pandi-Perumal SR, Wall S, Auguste E, Myers AK, et al. Obstructive sleep apnea and obesity: implications for public health. Sleep Med Disord. 2017;1:00019. https://www.ncbi.nlm.nih.gov/pubmed/29517065 .
Seet E, Nagappa M, Wong DT. Airway management in surgical patients with obstructive sleep apnea. Anesth Analg. 2021;132:1321–7. (PMID: 10.1213/ANE.0000000000005298)
Omalu BI, Ives DG, Buhari AM, Lindner JL, Schauer PR, Wecht CH, et al. Death rates and causes of death after bariatric surgery for Pennsylvania residents, 1995 to 2004. Arch Surg. 2007;142:923–8. Discussion 929. (PMID: 10.1001/archsurg.142.10.923)
Khorgami Z, Jackson TN, Aminian A, Sahawneh JM, Sclabas GM, Chow GS. Early cardiac complications after bariatric surgery: does the type of procedure matter?. Surg Obes Relat Dis. 2019;15:1132–7. https://doi.org/10.1016/j.soard.2019.03.030 . (PMID: 10.1016/j.soard.2019.03.03031151890)
O’Reilly E, Doherty L, O’Boyle C. How relevant is pre-operative obstructive sleep apnoea in the asymptomatic bariatric surgery patient? Obes Surg. 2020;30:969–74. https://pubmed.ncbi.nlm.nih.gov/31758473/ .
de Raaff CAL, de Vries N, van Wagensveld BA. Obstructive sleep apnea and bariatric surgical guidelines: summary and update. Curr Opin Anaesthesiol. 2018;31:104–9. (PMID: 10.1097/ACO.0000000000000542)
Memtsoudis SG, Stundner O, Rasul R, Chiu Y-L, Sun X, Ramachandran S-K, et al. The impact of sleep apnea on postoperative utilization of resources and adverse outcomes. Anesth Analg. 2014;118:407–18. (PMID: 10.1213/ANE.0000000000000051)
Kaw R, Pasupuleti V, Walker E, Ramaswamy A, Foldvary-Schafer N. Postoperative complications in patients with obstructive sleep apnea. Chest. 2012;141:436–41. (PMID: 10.1378/chest.11-0283)
Kong WT, Chopra S, Kopf M, Morales C, Khan S, Zuccala K, et al. Perioperative risks of untreated obstructive sleep apnea in the bariatric surgery patient: a retrospective study. Obes Surg. 2016;26:2886–90. (PMID: 10.1007/s11695-016-2203-3)
Benalcazar DA, Cascella M. Obesity surgery pre-op assessment and preparation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021.
de Raaff CA, Pierik AS, Coblijn UK, de Vries N, Bonjer HJ, van Wagensveld BA. Value of routine polysomnography in bariatric surgery. Surg Endosc. 2017;31:245–8. https://pubmed.ncbi.nlm.nih.gov/27177951/ .
Parente A, Legnani C, Bargagliotti M, Marullo M, Romagnoli S. Unicompartmental vs. total knee replacement in patients with failed high tibial osteotomy. Arch Orthop Trauma Surg. 2021. https://doi.org/10.1007/s00402-021-04093-7 .
American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014;120:268–86. (PMID: 10.1097/ALN.0000000000000053)
Haddad F, Bittencourt L. Recomendações para o diagnóstico e tratamento da síndrome da apneia obstrutiva do sono no adulto. São Paulo: Estação Brasil; 2013.
Mancini MC, editor. Diretrizes Brasileiras de Obesidade 2016. 4th ed. Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica. São Paulo, SP; 2016.
Kertes SS. Obstructive sleep apnea screening in pre-operative patients. Mil Med. 2020;185:21–7. (PMID: 10.1093/milmed/usz187)
Verbraecken J, Hedner J, Penzel T. Pre-operative screening for obstructive sleep apnoea. Eur Respir Rev. 2017;26:160012. https://doi.org/10.1183/16000617.0012-2016 .
Kaw R, Gali B, Collop NA. Perioperative care of patients with obstructive sleep apnea. Curr Treat Options Neurol. 2011;13:496–507. (PMID: 10.1007/s11940-011-0138-5)
O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004;14:23–6. (PMID: 10.1381/096089204772787248)
Nepomnayshy D, Hesham W, Erickson B, MacDonald J, Iorio R, Brams D. Sleep apnea: is routine pre-operative screening necessary? Obes Surg. 2013;23:287–91. (PMID: 10.1007/s11695-012-0806-x)
NIH Conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115:956–61. (PMID: 10.7326/0003-4819-115-12-956)
Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9. (PMID: 10.1161/01.CIR.100.10.1043)
Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ. 2005;173:627–34. (PMID: 10.1503/cmaj.050011)
STROBE. https://www.strobe-statement.org/ . Accessed 7 Aug 2021.
Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med. 2012;8:199–207. (PMID: 10.5664/jcsm.1784)
Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83. (PMID: 10.1381/096089203322509228)
Hewidy AA, Suliman LA, El Hefnawy E, Hassan AA. Immediate continuous positive airway pressure (CPAP) therapy after sleeve gastrectomy. Egypt J Chest Dis Tuberc. 2016;65:701–6. (PMID: 10.1016/j.ejcdt.2016.01.012)
Longitudinal Assessment of Bariatric Surgery (LABS) Consortium; Flum DR, Belle SH, King WC, Wahed AS, Berk P, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445–54. https://doi.org/10.1056/NEJMoa0901836 .
Chang S-H, Freeman NLB, Lee JA, Stoll CRT, Calhoun AJ, Eagon JC, et al. Early major complications after bariatric surgery in the USA, 2003-2014: a systematic review and meta-analysis. Obes Rev. 2018;19:529–37. (PMID: 10.1111/obr.12647)
Aminian A, Brethauer SA, Kirwan JP, Kashyap SR, Burguera B, Schauer PR. How safe is metabolic/diabetes surgery? Diabetes Obes Metab. 2015;17:198–201. (PMID: 10.1111/dom.12405)
Tsilingiris D, Koliaki C, Kokkinos A. Remission of type 2 diabetes mellitus after bariatric surgery: fact or fiction? Int J Environ Res Public Health. 2019;16:3171. https://doi.org/10.3390/ijerph16173171 .
Kelles SMB, Machado CJ, Barreto SM. Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization. Arq Bras Cir Dig. 2014;27:261–7. (PMID: 10.1590/S0102-67202014000400008)
Gupta PK, Gupta H, Kaushik M, Fang X, Miller WJ, Morrow LE, et al. Predictors of pulmonary complications after bariatric surgery. Surg Obes Relat Dis. 2012;8:574–81. (PMID: 10.1016/j.soard.2011.04.227)
Jensen C, Tejirian T, Lewis C, Yadegar J, Dutson E, Mehran A. Postoperative CPAP and BiPAP use can be safely omitted after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:512–4. (PMID: 10.1016/j.soard.2008.05.003)
Endeshaw Y, Rice TB, Schwartz AV, Stone KL, Manini TM, Satterfield S, et al. Snoring, daytime sleepiness, and incident cardiovascular disease in the health, aging, and body composition study. Sleep. 2013;36:1737–45. (PMID: 10.5665/sleep.3140)
Barbé F, Mayoralas LR, Duran J, Masa JF, Maimó A, Montserrat JM, et al. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial. Ann Intern Med. 2001;134:1015–23. (PMID: 10.7326/0003-4819-134-11-200106050-00007)
Peker Y, Glantz H, Eulenburg C, Wegscheider K, Herlitz J, Thunström E. Effect of positive airway pressure on cardiovascular outcomes in coronary artery disease patients with nonsleepy obstructive sleep apnea. The RICCADSA randomized controlled trial. Am J Respir Crit Care Med. 2016;194:613–20. (PMID: 10.1164/rccm.201601-0088OC)
Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med. 2004;169:668–72. (PMID: 10.1164/rccm.200308-1124PP)
Blume CA, Brust-Renck PG, Rocha MK, Leivas G, Neyeloff JL, Anzanello MJ, et al. Development and validation of a predictive model of success in bariatric surgery. Obes Surg. 2021;31:1030–7. (PMID: 10.1007/s11695-020-05103-0)
تواريخ الأحداث: Date Created: 20220105 Date Completed: 20220425 Latest Revision: 20221023
رمز التحديث: 20240628
DOI: 10.1038/s41366-021-01055-2
PMID: 34983957
قاعدة البيانات: MEDLINE