Positional obstructive sleep apnea in bariatric surgery patients: risk factor for postoperative cardiopulmonary complications?

Background: Up to 80 % of the bariatric surgery (BS) patients suffer from obstructive sleep apnea (OSA). BS patients with moderate to severe OSA (apnea-hypopnea index (AHI) ≥15) are usually treated with continuous positive airway pressure (CPAP). This is not indicated in mild OSA patients (AHI <15). However, >50 % of patients with mild OSA have positional OSA (POSA); their AHI is at least twice as high in supine sleeping position than in other positions. Since many patients sleep in supine position for surgical safety reasons after BS, evaluating the AHI in this position might be more relevant in this group. The aim of this study is to evaluate the postoperative cardiopulmonary complication rate in mild OSA patients with and without POSA. Secondary aim is to evaluate predictive factors for POSA.

Methods: A single-institute retrospective analysis was achieved with all consecutive patients who underwent primary laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy between 2006 and 2014. All patients with an AHI between 5 and 15 were included. Postoperative complications were compared between POSA and non-POSA patients. Predictive factors were evaluated through univariate and multivariable logistic regression analysis.

Results: A total of 277 patients, 153 with and 124 without POSA, were included. After BS, three patients (1.1 %) experienced severe cardiopulmonary complications. No significant difference was found between POSA and non-POSA patients. In multivariate analysis, age and BMI were found to be negative predictors for POSA.

Conclusion: In terms of 30-day postoperative cardiopulmonary outcome, CPAP therapy is not indicated in mild (P)OSA patients scheduled for BS.