Association of Obstructive Sleep Apnea and Postoperative Complications in Bariatric Surgery: How Crucial is Preoperative CPAP Compliance?

INTRODUCTION

Obesity is a progressive, multifactorial disease, associated to serious health complications such as type 2 diabetes, cardiovascular disease, and obstructive sleep apnea (OSA). OSA, prevalent in up to 71% of patients undergoing metabolic and bariatric surgery (MBS), is associated with increased postoperative risks. The first-line treatment for OSA is continuous positive airway pressure (CPAP), but adherence rates are often low, ranging from 30% to 60%. This study aims to evaluate the relationship between preoperative CPAP adherence and postoperative complications in patients with obesity undergoing MBS.

METHODS

The study included consecutive patients who underwent MBS between January 1, 2022, and January 1, 2024, excluding those without postoperative follow-up. The primary aim was to assess the association between preoperative OSA and postoperative complications following Roux-en-Y Gastric Bypass Surgery. OSA was screened using the STOP-BANG questionnaire, and patients with high scores underwent polysomnography for diagnosis. Postoperative complications were monitored using the Clavien-Dindo classification system.

RESULTS

Out of 322 screened patients, 242 were analyzed after excluding those lost to follow-up. The mean age was 42 years, with a mean BMI of 40.8 kg/m². Patients with OSA had more complications (10% in CPAP compliant vs. 11% in non-compliant) compared to non-OSA patients (1.9%). Complication-free survival rates were significantly longer in non-OSA patients, regardless of CPAP compliance (p = 0.021).

CONCLUSION

This study highlights a potential link between OSA and postoperative complications in MBS. While CPAP adherence may reduce risks, OSA remains a significant risk factor. Further research is needed to clarify the impacts of OSA and CPAP adherence on surgical outcomes.