Does every obese sleep apnea patients need CPAP treatment before bariatric surgery: Results of a validation study

Abstract

RATIONALE/OBJECTIVES: Due to a higher risk of postoperative complications in obstructive sleep apnea (OSA) patients, a systematic screening for OSA is recommended for patients undergoing bariatric surgery. We developed an algorithm based on the results of nocturnal oximetry and pCO2 to identify patients who should or should not be treated with continuous positive airway pressure (CPAP) before surgery. The objective of this study was to get validation data to determine if our algorithm safely selects subjects who need CPAP before surgery. METHODS/MEASUREMENTS: This is a retrospective cohort study. We looked for the occurrence of postoperative complications in 39 patients with moderate OSA not requiring CPAP treatment according to our algorithm, in 41 patients requiring CPAP, and in an historic group of 198 treated OSA patients. Untreated OSA patients were matched for oxygen desaturation index and body mass index to the treated patients in the historic group (1 untreated/2 treated matching). MAIN RESULTS: No statistical difference was found between treated and untreated OSA groups regarding cardiopulmonary complications (n = 0), length of hospital stay, 10 days reoperation and 30 days rehospitalization. Matching analysis showed similar results. CONCLUSIONS: The results of this validation study suggest that our preoperative screening algorithm may safely select patients who do not need CPAP before surgery. In the context of bariatric surgery, there is no increase in the occurrence of postoperative complications in patients with moderate OSA and no criteria for hypoventilation not receiving CPAP in the perioperative period. These results need to be confirmed in a large sample size study.