Screening for sleep-disordered breathing in a bariatric population
Kate Reed1, Martino F. Pengo1,2,3, Joerg Steier1,2
Background: Obstructive sleep apnoea (OSA) is the most common form of sleep-disordered breathing frequently associated with obesity. Obese subjects undergoing elective surgical procedures with general anaesthesia are potentially at risk if this condition is not identified. Our aim was to assess the prevalence of bariatric patients with undiagnosed OSA following pre-operative assessment and who could benefit from peri-procedural respiratory management.
Methods: Patients who were referred for prospective bariatric surgery were screened using the STOP-BANG questionnaire. If patients scored >4 points they underwent a home-based nocturnal pulse oximetry. Severity of OSA was defined by the 4% oxygen desaturation index (ODI) combined with a physician’s review. Data were compared using unpaired two-tailed t-test and chi-square test. Linear regression models were used to assess associations between clinical parameters.
Results: Sleep-disordered breathing of any degree was evident in 103 of 141 patients (73%). Thirteen (9%) patients had severe, 19 (13%) moderate, and 34 (24%) mild OSA, 38 (27%) patients had no OSA. Thirty-four (24%) patients were initiated on continuous positive airway pressure (CPAP) prior to the surgical procedure, 15 (11%) were admitted for further respiratory assessment and two of them were given CPAP following inpatient sleep study. Thirteen (9%) patients were advised to use a mandibular advancement device for mild but symptomatic OSA. Out of all patients, 76 (54%) were advised that no treatment was required.
Conclusions: OSA is highly prevalent in a cohort of bariatric surgery patients screened with STOP-BANG questionnaires. Almost 3/4 of this cohort have at least some degree of sleep-disordered breathing, and approximately half of them require a plan for the respiratory management perioperatively.