Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline

Christel A.L. de Raaff*, Marguerite A.W. Gorter-Stam, Nico de Vries, Ashish C. Sinha, H. Jaap Bonjer, Frances Chung, Usha K. Coblijn, Albert Dahan, Rick S. van den Helder, Antonius A.J. Hilgevoord, David R. Hillman, Michael P. Margarson, Samer G. Mattar, Jan P. Mulier, Madeline J.L. Ravesloot, Beata M.M. Reiber, Anne Sophie van Rijswijk, Preet Mohinder Singh, Roos Steenhuis, Mark TenhagenOlivier M. Vanderveken, Johan Verbraecken, David P. White, Nicole van der Wielen, Bart A. van Wagensveld

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background The frequency of metabolic and bariatric surgery (MBS) is increasing worldwide, with over 500,000 cases performed every year. Obstructive sleep apnea (OSA) is present in 35%–94% of MBS patients. Nevertheless, consensus regarding the perioperative management of OSA in MBS patients is not established. Objectives To provide consensus based guidelines utilizing current literature and, when in the absence of supporting clinical data, expert opinion by organizing a consensus meeting of experts from relevant specialties. Setting The meeting was held in Amsterdam, the Netherlands. Methods A panel of 15 international experts identified 75 questions covering preoperative screening, treatment, postoperative monitoring, anesthetic care and follow-up. Six researchers reviewed the literature systematically. During this meeting, the “Amsterdam Delphi Method” was utilized including controlled acquisition of feedback, aggregation of responses and iteration. Results Recommendations or statements were provided for 58 questions. In the judgment of the experts, 17 questions provided no additional useful information and it was agreed to exclude them. With the exception of 3 recommendations (64%, 66%, and 66% respectively), consensus (>70%) was reached for 55 statements and recommendations. Several highlights: polysomnography is the gold standard for diagnosing OSA; continuous positive airway pressure is recommended for all patients with moderate and severe OSA; OSA patients should be continuously monitored with pulse oximetry in the early postoperative period; perioperative usage of sedatives and opioids should be minimized. Conclusion This first international expert meeting provided 58 statements and recommendations for a clinical consensus guideline regarding the perioperative management of OSA patients undergoing MBS.

Original languageEnglish
Pages (from-to)1095-1109
Number of pages15
JournalSurgery for Obesity and Related Diseases
Volume13
Issue number7
DOIs
Publication statusPublished - 1 Jul 2017

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