title: Persistent moderate or severe obstructive sleep apnea after laparoscopic Roux-en-Y gastric bypass: which patients?
abstract: BACKGROUND
  Patients with severe obesity and obstructive sleep apnea (OSA) might decide to undergo bariatric surgery to improve this disease or, more specifically, to become independent of continuous positive airway pressure (CPAP) therapy, which is generally indicated in case of moderate and severe OSA. Knowledge of this topic is important for patient education on expectations of surgical outcome.
  
  
  OBJECTIVE
  To evaluate the prevalence and phenotypes of patients with persistent moderate to severe OSA after bariatric surgery.
  
  
  METHODS
  Obesity Center Amsterdam, Amsterdam, the Netherlands.
  
  
  METHODS
  Patients who underwent a laparoscopic Roux-en-Y gastric bypass, had a preoperative apnea-hypopnea index (AHI)≥15/hr, and of whom a follow-up AHI/hr was available were included.
  
  
  RESULTS
  Out of 437 patients, 205 underwent pre- and postoperative polysomnography; 232 (53.1%) were lost to follow-up. Median AHI was 32.3/hr (range, 15-138) and mean body mass index was 46 (standard deviation 7.2) kg/m2. A postoperative AHI<15/hr was achieved in 152 patients (74.1%), whereas 53 (25.9%) still had moderate or severe disease 8.6 (standard deviation 4.8) months postoperatively. Predictive factors for persistent moderate to severe disease were age≥50 years, preoperative AHI≥30/hr, excess weight loss (EWL)<60%, and hypertension (area under the curve: .772).
  
  
  CONCLUSIONS
  After bariatric surgery, around three quarters of the moderate to severe OSA patients had no or mild OSA, whereas one quarter (25.9%) still had moderate to severe OSA. Age≥50 years, preoperative AHI≥30/hr, EWL<60%, and hypertension were predictive factors for this persistent postoperative AHI≥15/hr.
authors.affiliation: Department of Surgery, OLVG West, Amsterdam, the Netherlands. Electronic address: c.deraaff@olvg.nl.
authors.forename: Christel A L
authors.initials: CA
authors.lastname: de Raaff
authors.affiliation: Department of Surgery, OLVG West, Amsterdam, the Netherlands.
authors.forename: Usha K
authors.initials: UK
authors.lastname: Coblijn
authors.affiliation: Department of Otolaryngology, AMC, Amsterdam, the Netherlands.
authors.forename: Madeline J L
authors.initials: MJ
authors.lastname: Ravesloot
authors.affiliation: Department of Otolaryngology, OLVG West, Amsterdam, the Netherlands.
authors.forename: Nico
authors.initials: N
authors.lastname: de Vries
authors.affiliation: Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: Elly S M
authors.initials: ES
authors.lastname: de Lange-de Klerk
authors.affiliation: Department of Surgery, OLVG West, Amsterdam, the Netherlands.
authors.forename: Bart A
authors.initials: BA
authors.lastname: van Wagensveld
mesh_terms: D015992:Body Mass Index; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000150:complications; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D017286:Polysomnography; D011183:Postoperative Complications / Q000209:etiology; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000628:therapy; D015431:Weight Loss
keywords: Bariatric surgery; Continuous positive airway pressure; Gastric bypass; LRYGB; Obstructive sleep apnea