title: Perioperative Risks of Untreated Obstructive Sleep Apnea in the Bariatric Surgery Patient: a Retrospective Study.
abstract: The use of continuous positive airway pressure (CPAP) perioperatively in bariatric surgery patients with obstructive sleep apnea (OSA) has been controversial. Although studies have demonstrated that CPAP use is safe in bariatric patients, prior studies have not shown improvement in outcomes in these patients.
  
  
  
  A retrospective review of patients who underwent bariatric surgery from 2005 to 2009 was performed. All patients underwent polysomnography preoperatively. Patient age, sex, BMI, comorbidities, polysomnogram data, type of bariatric procedure, length of hospital stay, and postoperative complications were reviewed. The Fisher exact test was used for statistical analysis.
  
  
  
  Among the 352 patients studied, 47 with apnea-hypopnea index (AHI) ≥5 did not receive CPAP postoperatively. A total of 7/47 (14.9 %) developed postoperative pulmonary complications. There were no non-pulmonary complications. Some 9/305 (2.95 %) with CPAP developed pulmonary complications. There were 26/305 patients with all-cause complications (8.52 %). The AHI was higher in the group receiving treatment. There was a statistically significant difference in pulmonary complications between patients with and those without treatment (p value 0.0002). The average length of stay was 3.0 and 3.2 days in treatment and comparison groups, respectively, a difference that did not reach statistical significance.
  
  
  
  Patients who did not receive CPAP postoperatively developed more pulmonary complications than those with CPAP, suggesting that CPAP might be beneficial in decreasing pulmonary complications in patients undergoing bariatric surgery. However, further investigation is warranted to better delineate other risk factors due to small sample size in our study group.
authors.affiliation: Department of Medicine, Danbury Hospital, Danbury, CT, USA.
authors.forename: Wing Tai
authors.initials: WT
authors.lastname: Kong
authors.affiliation: Jacksonville Hospitalists, Jacksonville, FL, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Chopra
authors.affiliation: Division of Hematology/Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kopf
authors.affiliation: Division of Colon and Rectal Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Morales
authors.affiliation: Internal Medicine/Hospital Medicine, UMass Memorial Medical Center, Worcester, MA, USA.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Khan
authors.affiliation: Division of Bariatric Surgery, General Surgery, Danbury Hospital, Danbury, CT, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Zuccala
authors.affiliation: Division of Bariatric Surgery, General Surgery, Danbury Hospital, Danbury, CT, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Choi
authors.affiliation: Department of Medicine, Division of Pulmonology and Sleep Medicine, Danbury Hospital, Danbury, CT, 06810, USA. john.chronakos@wchn.org.
authors.forename: John
authors.initials: J
authors.lastname: Chronakos
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D014481:United States
keywords: Bariatric surgery; Continuous positive airway pressure; Obstructive sleep apnea; Perioperative risk