title: Interest in bariatric surgery among obese patients with obstructive sleep apnea.
abstract: BACKGROUND
  Standard obstructive sleep apnea (OSA) therapies are poorly tolerated. Bariatric surgery is a potential alternative but the level of interest in this intervention among OSA patients is unknown.
  
  
  OBJECTIVE
  Determine the proportion of OSA patients who would be interested in bariatric surgery.
  
  
  METHODS
  Sleep clinics, United States.
  
  
  METHODS
  Consecutive adult patients with untreated severe OSA and a body mass index of 35-45 kg/m(2) were approached. Patients at low perioperative risk and no urgent indication for OSA treatment were invited to a separate informational visit about bariatric surgery as primary treatment for OSA.
  
  
  RESULTS
  Of 767 eligible patients, 230 (30.0%) were not at low perioperative risk, 49 (6.4%) had drowsy driving, and 16 (2.1%) had no insurance coverage for bariatric surgery. Of the remaining 482 patients, over one third (35.5%) were interested in bariatric surgery. Surgical interest was 47.2% in women versus 27.6% in men (P<0.01) and 67.3% in diabetics versus 31.0% in nondiabetics (P<0.01). In multivariable adjusted models, female gender (odds ratio 1.89, 95% CI [1.10-3.25]) and diabetes (odds ratio 3.97, 95% CI [1.97-8.01]) remained highly predictive of bariatric surgery interest.
  
  
  CONCLUSIONS
  Nearly two thirds of obese patients with severe OSA are good candidates for bariatric surgery. Among candidates, over one third are interested in this treatment. Interest rates are highest among women and diabetics, indicating that metabolic improvements continue to be a major driver of surgery even in patients with severe OSA. Given patient interest, the role of bariatric surgery should be routinely discussed with obese OSA patients.
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, United States. Electronic address: kdudley@partners.org.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Dudley
authors.affiliation: Center for Weight Management and Metabolic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States.
authors.forename: Ali
authors.initials: A
authors.lastname: Tavakkoli
authors.affiliation: Division of General, Minimally Invasive and Acute Care Surgery, North Shore-LIJ Lenox Hill Hospital, New York, New York, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Andrews
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, United States.
authors.forename: Ashley N
authors.initials: AN
authors.lastname: Seiger
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, United States.
authors.forename: Jessie P
authors.initials: JP
authors.lastname: Bakker
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, United States.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Patel
mesh_terms: D000328:Adult; D000367:Age Factors; D050110:Bariatric Surgery / Q000379:methods* / Q000706:statistics & numerical data; D015992:Body Mass Index; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010358:Patient Participation / Q000706:statistics & numerical data*; D018579:Patient Selection; D017286:Polysomnography / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Bariatric surgery; Diabetes; Obesity; Obstructive sleep apnea; Perioperative risk