Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Anesthesia
Published in: Journal of Anesthesia 6/2014

Open Access 01-12-2014 | Original Article

STOP-Bang and the effect on patient outcome and length of hospital stay when patients are not using continuous positive airway pressure

Authors: Monika A. Proczko, Pieter S. Stepaniak, Marcel de Quelerij, Floor Haak van der Lely, J. (Frans) Smulders, Lukasz Kaska, Mohammed A. Soliman Hamad

Published in: Journal of Anesthesia | Issue 6/2014

Login to get access

Abstract

Background

In patients undergoing surgical interventions under general anesthesia, obstructive sleep apnea syndrome (OSA) can cause serious perioperative cardiovascular or respiratory complications leading to fatal consequences, even sudden death. In this study we test the hypothesis that morbidly obese patients diagnosed by a polysomnography test and using continuous positive airway pressure (CPAP) therapy have fewer and less severe perioperative complications and a shorter hospital stay than patients who have a medical history that meets at least three STOP-Bang criteria and are not using CPAP therapy.

Methods

Postoperative hospital stay and pulmonary complications were analyzed in three groups of morbidly obese patients undergoing bariatric surgery (Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy) between January 2009 and November 2013 (n = 693). Group A comprised 99 patients who were preoperatively diagnosed with OSA based on polysomnography results. These patients used CPAP therapy before and after surgery. Group B consisted of 182 patients who met at least three STOP-Bang criteria but who were not diagnosed with OSA based on polysomnography results. These patients did not use CPAP. Group C, the reference group, comprised 412 patients who scored one to two items on the STOP-Bang.

Results

During the perioperative period, Group B patients had a significantly (p < 0.001) higher cumulative rate of pulmonary complications, worse oxygen saturation, respiratory rates, and increased length of stay in hospital. There was also two cases of sudden death in this group.

Conclusion

Based on these results, we conclude that patients meeting at least three STOP-BANG criteria have higher postoperative complications and an increased length of hospital stay than patients using CPAP.
Literature
1.
Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: A population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217–39.PubMedCrossRef
2.
Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13(5):676–83.PubMedCrossRef
3.
Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R, Maislin G, Pack AI. Identification of upper airway anatomic risk factors for obstructive sleep apnea 375 with volumetric magnetic resonance imaging. Am J Respir Crit Care Med. 2003;168(5):522–30.PubMedCrossRef
4.
Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352(12):1206–14.PubMedCrossRef
5.
Duran-Cantolla J, Aizpuru F, Martinez-Null C, Barbe-Illa F. Obstructive sleep apnea/hypopnea and systemic hypertension. Sleep Med Rev. 2009;13(5):323–31.PubMedCrossRef
6.
Gami AS, Olson EJ, Shen WK, Wright RS, Ballman KV, Hodge DO, Herges RM, Howard DE, Somers VK. Obstructive Sleep Apnea and the risk of sudden cardiac death A Longitudinal study of 10,701 adults. J Am Coll Cardiol. 2013;62(7):610–6.PubMedCrossRef
7.
Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC. Hernandez AV meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109:897.PubMedCrossRef
8.
Weingarten TN, Flores AS, McKenzie JA, Nguyen LT, Robinson WB, Kinney TM, Siems BT, Wenzel PJ, Sarr MG, Marienau MS, Schroeder DR, Olson EJ, Morgenthaler TI, Warner DO, Sprung J. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth. 2011;106(1):131–9.PubMedCrossRef
9.
Tuomilehto H, Seppä J, Uusitupa M. Obesity and obstructive sleep apnea—clinical significance of weight loss. Sleep Med Rev. 2013;17(5):321–9.PubMedCrossRef
10.
Paje DT, Kremer MJ. The perioperative implications of obstructive sleep apnea. Orthop Nurs. 2006;25(5):291–9.PubMedCrossRef
11.
Lopes Neto JM, Brandão LO, Loli A, Leite CV, Weber SA. Evaluation of obstructive sleep apnea in obese patients scheduled for bariatric surgery. Acta Cir Bras. 2013;28(4):317–22.PubMedCrossRef
12.
Khan A, King WC, Patterson EJ, Laut J, Raum W, Courcoulas AP, Atwood C, Wolfe BM. Assessment of obstructive sleep apnea in adults undergoing bariatric surgery in the longitudinal assessment of bariatric surgery-2 (LABS-2) study. J Clin Sleep Med. 2013;9(1):21–9.PubMedCentralPubMed
13.
Hallowell PT, Stellato TA, Schuster M, Graf K, Robinson A, Crouse C, Jasper JJ. Potentially life-threatening sleep apnea is unrecognized without aggressive evaluation. Am J Surg. 2007;193(3):364–7.PubMedCrossRef
14.
Palla A, Digiorgio M, Carpenè N, Rossi G, D’Amico I, Santini F, Pinchera A. Sleep apnea in morbidly obese patients: prevalence and clinical predictivity. Respiration. 2009;78(2):134–40.PubMedCrossRef
15.
Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263.PubMed
16.
O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004;14(1):23–6.PubMedCrossRef
17.
Shiota S, Inoue Y, Takekawa H, Kotajima M, Nakajyo M, Usui C, Yoshioka Y, Koga T, Takahashi K. Effect of continuous positive airway pressure on regional cerebral blood flow during wakefulness in obstructive sleep apnea. Sleep Breath. 2014;18(2):289–95.PubMedCrossRef
18.
Bakker JP, Balachandran JS, Tecilazich F, Deyoung PN, Smales E, Veves A, Malhotra A. Pilot study of the effects of bariatric surgery and continuous positive airway pressure treatment on vascular function in obese subjects with obstructive sleep apnoea. Intern Med J. 2013;43(9):993–8. doi:10.​1111/​imj.​12224.PubMedCentralPubMedCrossRef
19.
Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812–21.PubMedCrossRef
20.
Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg. 2013;23(12):2050–7.PubMedCrossRef
21.
van Zeller M, Severo M, Santos AC, Drummond M. 5-Years APAP adherence in OSA patients—Do first impressions matter? Respir Med. 2013.107(12):2046–52.
22.
23.
24.
25.
Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, Kader G, Mahowald M, Younger J, Pack AI. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007;30(6):711–9.PubMedCentralPubMed
26.
Kaw R, Pasupuleti V, Walker E, Ramaswamy A, Foldvary-Schafer N. Postoperative complications in patients with obstructive sleep apnea. Chest. 2012;141(2):436–41.PubMedCrossRef
27.
Memtsoudis SG, Liu SS, Ma Y, Chiu YL, Walz JM, Gaber-Baylis LK, Mazumdar M. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg. 2011;112:113–21.PubMedCrossRef
28.
Liao P, Yegneswaran B, Vairavanathan S, Zilberman P, Chung F. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anesth. 2009;56:819–28.PubMedCrossRef
29.
Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO. Sleep-disordered breathing and postoperative outcomes after bariatric surgery: Analysis of the nationwide inpatient sample. Obes Surg. 2013;23:1842–51.PubMedCentralPubMedCrossRef
30.
Deutsch PA, Simmons MS, Wallace JM. Cost-effectiveness of split-night polysomnography and home studies in the evaluation of obstructive sleep apnea syndrome. J Clin Sleep Med. 2006;2(2):145–53.PubMed
31.
de Quelerij M, van Velzen C, Luitwieler R, Meijer N, Gadiot RPM, van der Voet J, van der Klooster J, de Feiter PW, Mannaerts G, Verbrugge SJC. Prevalence and determinants of complications in a bariatric ICU population. NTVA. 2012;12(25):16–21.
32.
Van den Broek RJ, Buise MP, van Dielen FM, Bindels AJ, van Zundert AA, Smulders JF. Characteristics and outcome of patients admitted to the ICU following bariatric surgery. Obes Surg. 2009;19(5):560–4.PubMedCrossRef
33.
Yetkin O, Kunter E, Gunen H. CPAP compliance in patients with obstructive sleep apnea syndrome. Sleep Breath. 2008;12(4):365–7.PubMedCrossRef
Metadata
Title
STOP-Bang and the effect on patient outcome and length of hospital stay when patients are not using continuous positive airway pressure
Authors
Monika A. Proczko
Pieter S. Stepaniak
Marcel de Quelerij
Floor Haak van der Lely
J. (Frans) Smulders
Lukasz Kaska
Mohammed A. Soliman Hamad
Publication date
01-12-2014
Publisher
Springer Japan
Published in
Journal of Anesthesia / Issue 6/2014
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-014-1848-0

Other articles of this Issue 6/2014

Journal of Anesthesia 6/2014 Go to the issue

Original Article

Isoflurane anesthetic hypersensitivity and progressive respiratory depression in a mouse model with isolated mitochondrial complex I deficiency

Letter to the Editor

Myotonic dystrophy diagnosed after cesarean section

Original Article

Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials

Original Article

Accuracy of the CNAP™ monitor, a noninvasive continuous blood pressure device, in providing beat-to-beat blood pressure measurements during bariatric surgery in severely obese adolescents and young adults

Original Article

The effects of 2-chloroprocaine on coagulation and fibrinolysis in the parturient: an in vitro study

Letter to the Editor

Comment on an article by Ahuja et al.