Preoperative Assessment of Obstructive Sleep Apnea in Bariatric Patients Using Polysomnography or Polygraphy

• Published in: Obesity surgery Vol. 32; no. 6; pp. 1814 - 1821
• Main Authors: van Veldhuisen, Sophie L., Nijland, Leontien M. G., Ravesloot, Madeline J. L., de Vries, Nico, van Veen, Ruben N., Hazebroek, Eric J., de Castro, Steve M. M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-06-2022; Springer Nature B.V
• Subjects: Bariatric Surgery; Continuous Positive Airway Pressure; Gastrointestinal surgery; Humans; Male; Medicine; Medicine & Public Health; Obesity, Morbid - surgery; Original Contributions; Polysomnography; Retrospective Studies; Sleep apnea; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - therapy; Surgery; Polygraphy; Polysomnography; Preoperative care; Continuous positive airway pressure; Obstructive sleep apnea; Bariatric surgery
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-022-06038-4

Background
Preoperative assessment of obstructive sleep apnea (OSA) in patients scheduled for bariatric surgery can be performed by in-laboratory polysomnography (PSG) or by portable polygraphy (PP) at home. We aimed to evaluate the association between PSG/PP, OSA diagnosis, and implementation of continuous positive airway pressure (CPAP) therapy.
Methods
All patients who underwent bariatric surgery from 2015 to 2017 were retrospectively reviewed. Patients underwent preoperative PSG or PP, based on prevailing protocols or at the physician’s discretion. Logistic regression analyses were performed to determine predictors of CPAP implementation. OSA-related postoperative complications were analyzed in both groups.
Results
During the study period, 1464 patients were included. OSA was diagnosed in 79% of 271 patients undergoing PSG, compared to 64% of 1193 patients undergoing PP (
p
 < 0.001), with median apnea–hypopnea index (AHI) of 15.8 and 7.7, respectively. CPAP treatment was initiated in 52% and 27% of patients, respectively,
p
 < 0.001. Predictors (with adjusted odds ratio) in multivariate regression analysis for CPAP implementation were as follows: male gender (5.15), BMI ≥ 50 (3.85), PSG test (2.74), hypertension (2.38), and age ≥ 50 (1.87). OSA-related complications did not differ between groups (
p
 = 0.277).
Conclusion
Both PSG and PP are feasible options for preoperative OSA assessment in bariatric patients. When PP is performed, some underdiagnosis may occur as cases of mild OSA may be missed. However, clinically relevant OSA is detected by both diagnostic tools. No difference in OSA-related complications was found. PP is a safe, less invasive option and can be considered as a suitable measure for OSA assessment in this population.