Evaluation of CPAP adherence in bariatric patients diagnosed with obstructive sleep apnea: outcomes of a multicenter cohort study.

Autor: van Veldhuisen SL; Department of Surgery/Vitalys Clinic, Department of Bariatric Surgery, Wagnerlaan 55, 6815 AD, Rijnstate, Arnhem, the Netherlands. svanveldhuisen@rijnstate.nl., van Boxel MF; Department of Surgery/Vitalys Clinic, Department of Bariatric Surgery, Wagnerlaan 55, 6815 AD, Rijnstate, Arnhem, the Netherlands., Wiezer MJ; Department of Surgery, St. Antonius Hospital, Utrecht, the Netherlands., van Veen RN; Department of Surgery, OLVG, Amsterdam, the Netherlands., de Castro SMM; Department of Surgery, OLVG, Amsterdam, the Netherlands., Swank DJ; Dutch Obesity Clinic, the Hague, the Netherlands., Demirkiran A; Department of Surgery, Rode Kruis Hospital, Beverwijk, the Netherlands., Boerma EG; Department of Surgery, Zuyderland Hospital, Heerlen, the Netherlands., Greve JWM; Department of Surgery, Zuyderland Hospital, Heerlen, the Netherlands.; Department of Surgery, Nutrim, Maastricht University, Maastricht, the Netherlands., van Dielen FMH; Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands., Kuppens K; Department of Pulmonary Medicine, St. Antonius Hospital, Utrecht, the Netherlands., Hazebroek EJ; Department of Surgery/Vitalys Clinic, Department of Bariatric Surgery, Wagnerlaan 55, 6815 AD, Rijnstate, Arnhem, the Netherlands. ehazebroek@rijnstate.nl.; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands. ehazebroek@rijnstate.nl.
Jazyk: angličtina
Zdroj: Sleep & breathing = Schlaf & Atmung [Sleep Breath] 2023 May; Vol. 27 (2), pp. 535-544. Date of Electronic Publication: 2022 May 27.
DOI: 10.1007/s11325-022-02643-w
Abstrakt: Purpose: Obstructive sleep apnea (OSA) is highly prevalent but mostly undiagnosed in obese patients scheduled for bariatric surgery. To prevent cardiopulmonary complications, many clinics perform preoperative OSA screening. Consequently, adequate adherence to continuous positive airway pressure (CPAP) therapy is essential but challenging. We aimed to evaluate CPAP adherence and its influence on postoperative outcomes.
Methods: In a prospective multicenter cohort study, we compared different perioperative strategies for handling undiagnosed OSA in bariatric patients. In this subgroup analysis, patients newly diagnosed with OSA were compared to those with pre-existing OSA. We assessed inadequate CPAP adherence, defined as < 4 h/night, between the preoperative period and 6 months postoperative. Cardiopulmonary complications and (un)scheduled ICU admissions were also evaluated.
Results: In total, 272 patients with newly diagnosed OSA (67.4%) and 132 patients with pre-existing OSA (32.6%) were included. Before surgery, 41 newly diagnosed patients used CPAP inadequately, compared to 5 patients with pre-existing OSA (15% vs. 4%, p = 0.049). Six months after surgery, inadequate CPAP use increased to 73% for newly diagnosed patients and 39% for patients with pre-existing OSA, respectively (p < 0.001). Incidences of cardiopulmonary complications, scheduled, and unscheduled ICU admissions were similar in the two study groups (p = 0.600, p = 0.972, and p = 0.980, respectively).
Conclusion: Inadequate CPAP adherence is higher in bariatric patients newly diagnosed with OSA when compared to patients with pre-existing OSA. Strategies to increase CPAP adherence may be valuable when considering routine OSA screening and CPAP therapy in patients undergoing bariatric surgery. Further studies are needed to improve current guidelines on perioperative OSA management of obese patients.
Trial Registration: POPCORN study, registered at Netherlands Trial Register, https://www.trialregister.nl/trial/6805 . ID no: 6805.
(© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Databáze: MEDLINE
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