Evidence supporting routine polysomnography before bariatric surgery
Evidence supporting routine polysomnography before bariatric surgery
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DOI：
10.1381/096089204772787248
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发表时间：
2004-01-01
期刊：
影响因子：
2.9
通讯作者：
Patterson, EJ
中科院分区：
文献类型：
--
作者：
O'Keeffe, T;Patterson, EJ
背景：阻塞性睡眠呼吸暂停（OSA）在病态肥胖患者中很常见，据报道患病率为12%至40%。OSA的术前诊断对于围手术期气道管理和术后肺部并发症的预防具有重要意义。据报道，BMI是一个独立的风险因素，最近被用于评分系统，以帮助预测阻塞性睡眠呼吸暂停。我们的假设是，阻塞性睡眠呼吸暂停在接受减肥手术的患者中非常普遍，仅靠BMI并不能很好地预测是否存在睡眠呼吸暂停。方法：一项横断面研究是对最近170名连续在同一外科医生诊所接受减肥手术的患者进行的。临床和人口统计数据可从我们的前瞻性数据库中获得，并对多导睡眠图结果进行回顾性回顾。睡眠呼吸暂停被记录为存在或不存在，并从轻度到重度分级。根据BMI将患者人群分为重度肥胖（BMI 35-39.9）、病态肥胖（BMI 40-49.9）、超肥胖（BMI 50-59.9）和超超肥胖（BMI大于等于60）。结果：170例患者术前确诊OSA 26例（15.3%）。7例患者（4.1%）没有睡眠研究。其余137例患者（80.6%）有可用的睡眠数据，105例（76.6%）有睡眠呼吸暂停（基于美国睡眠医学委员会的标准）。睡眠呼吸暂停与BMI没有相关性。该队列中OSA的总患病率为77%（131/170）。结论：在这个大的患者队列中，睡眠呼吸暂停很普遍（77%），独立于BMI，大多数病例在减肥手术会诊前没有被诊断出来。这些数据支持在减肥手术前使用常规筛查多导睡眠图。
Background: Obstructive sleep apnea (OSA) is common in morbidly obese patients, with a reported prevalence from 12 to 40%. Preoperative diagnosis of OSA is important for both perioperative airway management and the prevention of postoperative pulmonary complications. BMI has been reported to be an independent risk factor, and has been used recently in scoring systems to help predict OSA. Our hypothesis was that OSA is highly prevalent in patients presenting for bariatric surgery, and that BMI alone is not a good predictor of the presence or absence of sleep apnea.Methods: A cross-sectional study was undertaken of the last 170 consecutive patients presenting for bariatric surgery in a single surgeon's practice. Clinical and demographic data were available from our prospective database, and polysomnography results were reviewed retrospectively. Sleep apnea was noted as present or absent, and graded from mild to severe. The patient population was stratified by BMI into severely obese (BMI 35-39.9), morbidly obese (BMI 40-49.9), super-obese (BMI 50-59.9), and super-super-obese (BMIgreater than or equal to60).Results: OSA had been diagnosed before surgical consultation in 26 of the 170 patients (15.3%). Sleep studies were not available in 7 patients (4.1%). The remaining 137 patients (80.6%) had sleep data available, and 105 (76.6%) had sleep apnea (based on American Board of Sleep Medicine criteria). There was no correlation of sleep apnea with BMI. The overall prevalence of OSA in this cohort was 77% (131/170).Conclusions: In this large patient cohort, sleep apnea was prevalent (77%) independent of BMI, and most cases were not diagnosed before bariatric surgical consultation. These data support the use of routine screening polysomnography before bariatric surgery.