title: Value of routine polysomnography in bariatric surgery.
abstract: Obstructive sleep apnea (OSA), present in 60-70 % of bariatric surgery patients, is a potentially life-threatening condition when not detected and managed appropriately. The best available method to identify the severity of OSA is polysomnography. However, routine polysomnography measurements have not been accepted as standard modality in bariatric surgery. We report our experience with routine polysomnography in a cohort of patients undergoing bariatric surgery to determine the true prevalence of OSA with respect to the different severity levels as determined by the apnea-hypopnea index (AHI).
  
  
  
  AHI data were retrospectively collected from all patients who underwent bariatric surgery from 2012 onward, when the performance of preoperative polysomnography became mandatory. Mild, moderate and severe OSA were defined as an AHI ≥5, ≥15 and ≥30/h, respectively. Prevalence and number needed to screen (NNS) were calculated for all OSA severity levels.
  
  
  
  A total of 1358 patients were included. OSA was detected in 813 (59.9 %; NNS: 2) patients. Moreover, 405 (29.8 %; NNS: 4) patients were diagnosed with an AHI ≥15/h and 213 (15.7 %; NNS: 7) with severe OSA (AHI ≥30/h). Extreme AHI thresholds of ≥60 and ≥90/h were detected in 79 (5.8 %; NNS: 18) and 17 (1.3 %; NNS: 77) patients, respectively.
  
  
  
  One-third of the bariatric surgery patients have an AHI ≥15/h and would benefit from continuous positive airway pressure therapy. In order to increase perioperative safety and avoid the preventable risk of perioperative complications, we recommend mandatory P(S)G prior to bariatric surgery.
authors.affiliation: Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. c.deraaff@olvg.nl.
authors.forename: Christel A L
authors.initials: CA
authors.lastname: de Raaff
authors.affiliation: Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
authors.forename: Annouk S
authors.initials: AS
authors.lastname: Pierik
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Usha K
authors.initials: UK
authors.lastname: Coblijn
authors.affiliation: Department of Otolaryngology, OLVG West, Amsterdam, The Netherlands.|Department of Oral Kinesiology, ACTA, Amsterdam, The Netherlands.|Department of Otolaryngology, Head and Neck Surgery, UZA, Antwerp, Belgium.
authors.forename: Nico
authors.initials: N
authors.lastname: de Vries
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: H Jaap
authors.initials: HJ
authors.lastname: Bonjer
authors.affiliation: Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
authors.forename: Bart A
authors.initials: BA
authors.lastname: van Wagensveld
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D011300:Preoperative Care; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*
keywords: Bariatric surgery; Continuous positive airway pressure; Gastric bypass; Obstructive sleep apnea