title: Potentially life-threatening sleep apnea is unrecognized without aggressive evaluation.
abstract: BACKGROUND
  Many patients undergoing bariatric surgery have severe comorbidities, including obstructive sleep apnea (OSA). We suspected that sleep apnea was underdiagnosed in our study population.
  
  
  METHODS
  A retrospective chart review of our bariatric database was conducted comparing OSA evaluation based on clinical parameters (Era 1) with mandatory OSA evaluation for all patients (Era 2).
  
  
  RESULTS
  In both Era groups approximately 19% of patients presented to our program with an established diagnosis of OSA. In Era 1 this increased to 56% based on clinical parameters and in Era 2 this increased to 91% with mandatory polysomnography testing of all patients.
  
  
  CONCLUSIONS
  OSA is grossly underdiagnosed in patients with morbid obesity presenting for bariatric surgery. Clinical evaluation continues to miss a substantial percentage of patients with OSA. Mandatory testing of all patients for OSA with polysomnography before bariatric surgery is recommended.
authors.affiliation: Department of Surgery Case Medical School and Bariatric Surgery Program, University Hospitals Case Medical Center, 11100 Euclid Ave., Cleveland, OH 44106, USA. Peter.hallowell@uhhs.com
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Stellato
authors.forename: Margaret
authors.initials: M
authors.lastname: Schuster
authors.forename: Kristen
authors.initials: K
authors.lastname: Graf
authors.forename: Ann
authors.initials: A
authors.lastname: Robinson
authors.forename: Cathleen
authors.initials: C
authors.lastname: Crouse
authors.forename: John J
authors.initials: JJ
authors.lastname: Jasper
mesh_terms: D000328:Adult; D000368:Aged; D049088:Bariatrics / Q000379:methods; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D009820:Ohio / Q000453:epidemiology; D017286:Polysomnography; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology