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Sleep and Breathing
Published in: Sleep and Breathing 2/2023

27-05-2022 | Sleep Apnea | Sleep Breathing Physiology and Disorders • Original Article

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

Authors: S. L. van Veldhuisen, M. F. van Boxel, M. J. Wiezer, R. N. van Veen, S. M. M. de Castro, D. J. Swank, A. Demirkiran, E. G. Boerma, J. W. M. Greve, F. M. H. van Dielen, K. Kuppens, E. J. Hazebroek

Published in: Sleep and Breathing | Issue 2/2023

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Abstract 

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.
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Metadata
Title
Evaluation of CPAP adherence in bariatric patients diagnosed with obstructive sleep apnea: outcomes of a multicenter cohort study
Authors
S. L. van Veldhuisen
M. F. van Boxel
M. J. Wiezer
R. N. van Veen
S. M. M. de Castro
D. J. Swank
A. Demirkiran
E. G. Boerma
J. W. M. Greve
F. M. H. van Dielen
K. Kuppens
E. J. Hazebroek
Publication date
27-05-2022
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 2/2023
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-022-02643-w

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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