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2010 Annual Meeting Abstracts

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Assessing the need for routine OSA screening in bariatric patients
Walid M Hesham, Dimitry Nepomnayshay, *Kai Hammerich, *Pam Obrien, *Julie McDonald
Lahey Clinic, Burlington, MA

Objective:Presence of sleep apnea is between 40-50% in morbidly obese bariatric surgery patients. Since the perioperative complications of unrecognized sleep apnea (OSA) can be severe, many bariatric surgery programs promote routine screening for this disorder. However, most obese patients undergoing non-bariatric surgery do not get screened, and to date, there is little evidence to support routine OSA screening in bariatric patients. We hypothesize that it may not be necessary to screen all bariatric surgery patients pre-operatively for sleep apnea.
Design:Retrospective chart review
Setting:Bariatric center of excellence tertiary teaching hospital
Patients:882 morbidly obese patients (BMI>40) undergoing either bariatric surgery (n=467) or orthopedic surgery (joint replacements n=415)
Main Outcome Measures:
Cardio-pulmonary complications - defined as death, aspiration, atelectasis, reintubation, hypoxemia, BIPAP requirement, and other cardiac complications - were recorded
Results:Sleep apnea was found in 42.4% of patients undergoing bariatric surgery compared to 17.3% of patients undergoing orthopedic surgery, despite the BMI being higher (p=.0003) in the orthopedic surgery arm. Therefore, lack of screening resulted in a 25% incidence of undiagnosed sleep apnea in the orthopedic surgery arm. Despite having a significant percentage of patients with undiagnosed OSA in the orthopedic surgery arm, risk adjusted cardiopulmonary complications were not significantly higher compared to the bariatric surgery patients without sleep apnea (p=0.4811), which was the lowest risk group.
Conclusions:Sleep apnea screening prior to bariatric surgery incorporates a large percentage of patients with mild sleep apnea that may be of no clinical significance. Future prospective studies will be useful in assessing the need for routine OSA screening of patients undergoing bariatric surgery.

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