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 Tenhagen; Olivier M Vanderveken; Johan Verbraecken; David P White; Nicole van der Wielen; Bart A van Wagensveld

doi:10.1016/j.soard.2017.03.022

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

Surg Obes Relat Dis. 2017 Jul;13(7):1095-1109. doi: 10.1016/j.soard.2017.03.022. Epub 2017 Mar 30.

Authors

Christel A L de Raaff¹, Marguerite A W Gorter-Stam², Nico de Vries³, Ashish C Sinha⁴, H Jaap Bonjer², Frances Chung⁵, Usha K Coblijn², Albert Dahan⁶, Rick S van den Helder⁷, Antonius A J Hilgevoord⁸, David R Hillman⁹, Michael P Margarson¹⁰, Samer G Mattar¹¹, Jan P Mulier¹², Madeline J L Ravesloot¹³, Beata M M Reiber¹⁴, Anne-Sophie van Rijswijk¹⁵, Preet Mohinder Singh¹⁶, Roos Steenhuis¹⁷, Mark Tenhagen¹⁴, Olivier M Vanderveken¹⁸, Johan Verbraecken¹⁹, David P White²⁰, Nicole van der Wielen², Bart A van Wagensveld²¹

Affiliations

¹ Department of Surgery, OLVG West, Amsterdam, the Netherlands. Electronic address: c.deraaff@olvg.nl.
² Department of Surgery, VU Medical Center, Amsterdam, the Netherlands.
³ Department of Oral Kinesiology, ACTA, Amsterdam, the Netherlands; Department of Otorhinolaryngology and Head and Neck Surgery, Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology, OLVG West, Amsterdam, the Netherlands.
⁴ Department of Anesthesiology and Perioperative Medicine, Temple University, Philadelphia, PA, USA.
⁵ Department of Anesthesiology, University Health Network, University of Toronto, Toronto, Canada.
⁶ Department of Anesthesiology, LUMC, Leiden, the Netherlands.
⁷ Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands.
⁸ Department of Clinical Neurophysiology, OLVG West, Amsterdam, the Netherlands.
⁹ Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
¹⁰ Department of Anaesthesia, Saint Richard's Hospital, Chichester, United Kingdom.
¹¹ Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA.
¹² Department of Anesthesiology, AZ Sint Jan, Brugge, Belgium.
¹³ Department of Otorhinolaryngology, OLVG West, Amsterdam, the Netherlands.
¹⁴ Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands.
¹⁵ Department of Surgery, MC Slotervaart, Amsterdam, the Netherlands.
¹⁶ Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
¹⁷ Medical Library, OLVG West, Amsterdam, the Netherlands.
¹⁸ Department of Otorhinolaryngology and Head and Neck Surgery, Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
¹⁹ Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
²⁰ Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.
²¹ Department of Surgery, OLVG West, Amsterdam, the Netherlands.

PMID: 28666588
DOI: 10.1016/j.soard.2017.03.022

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.

Keywords: Anesthesia; Bariatric surgery; Consensus guideline; Continuous positive airway pressure; Obstructive sleep apnea; Postoperative monitoring.

Publication types

Consensus Development Conference
Practice Guideline

MeSH terms

Aftercare / methods
Anesthesia / methods
Bariatric Surgery / methods*
Continuous Positive Airway Pressure / methods
Humans
Obesity, Morbid / complications
Obesity, Morbid / surgery*
Perioperative Care / methods*
Risk Assessment / methods
Sleep Apnea, Obstructive / complications
Sleep Apnea, Obstructive / therapy*