Obesity-associated sleep hypoventilation and increased adverse postoperative bariatric surgery outcomes in a large clinical retrospective cohort

• Published in: Journal of clinical sleep medicine 2022-12, Vol.18 (12), p.2793-2801
• Main Authors: Chindamporn, Pornprapa, Wang, Lu, Bena, James, Zajichek, Alexander, Milinovic, Alex, Kaw, Roop, Kashyap, Sangeeta R, Cetin, Derrick, Aminian, Ali, Kempke, Nancy, Foldvary-Schaefer, Nancy, Aboussouan, Loutfi S, Mehra, Reena
• Format: Article
• Language: English
• Subjects: Bariatric Surgery - adverse effects; Body Mass Index; Carbon Dioxide; Female; Humans; Hypoventilation - complications; Male; Obesity - complications; Obesity Hypoventilation Syndrome - complications; Obesity Hypoventilation Syndrome - epidemiology; Retrospective Studies; Scientific Investigations; Sleep
• ISSN: 1550-9389; 1550-9397
• DOI: 10.5664/jcsm.10216

Although obesity hypoventilation syndrome (OHS) is associated with increased morbidity and mortality, post-bariatric surgery OHS risk remains unclear due to often nonsystematic OHS assessments. We leverage a clinical cohort with nocturnal CO monitoring during polysomnography to address the hypothesis that patients with obesity-associated sleep hypoventilation (OaSH; ie, stage II OHS) have increased adverse postoperative bariatric surgery outcomes. We retrospectively analyzed data from patients undergoing pre-bariatric surgery polysomnography at the Cleveland Clinic from 2011-2018. OaSH was defined by body mass index ≥ 30 kg/m and either polysomnography-based end-tidal CO ≥ 45 mmHg or serum bicarbonate ≥ 27 mEq/L. Outcomes considered were as follows: intensive care unit stay, intubation, tracheostomy, discharge disposition other than home or 30-day readmission individually and as a composite, and all-cause mortality. Two-sample test or Wilcoxon rank-sum test for continuous variables and chi-square or Fisher's exact test for categorical variables were used for OaSH vs non-OaSH comparisons. All-cause mortality was compared using Kaplan-Meier estimation and Cox proportional hazards models. The analytic sample (n = 1,665) was aged 45.2 ± 12 years, 20.4% were male, had a body mass index of 48.7 ± 9 kg/m , and 63.6% were White. OaSH prevalence was 68.5%. OaSH patients were older and more likely to be male with a higher BMI, apnea-hypopnea index, and glycated hemoglobin. The composite outcome was higher in OaSH vs non-OaSH patients (18.9% vs 14.3%, = .021). Although some individual outcomes were respectively higher in OaSH vs non-OaSH patients, differences were not statistically significant: intubation (1.5% vs 1.3%, = .81) and 30-day readmission (13.8% vs 11.3%, = .16). Long-term mortality (median follow-up: 22.9 months) was not significantly different between groups, likely due to overall low event rate (hazard ratio = 1.39, 95% confidence interval: 0.56, 3.42). In this largest sample to date of systematically phenotyped OaSH in a bariatric surgery cohort, we identify increased postoperative morbidity in those with sleep-related hypoventilation in stage II OHS when a composite outcome was considered, but individual contributors of intubation, intensive care unit admission, and hospital length of stay were not increased. Further study is needed to identify whether perioperative treatment of OaSH improves post-bariatric surgery outcomes. Chindamporn P, Wang L, Ben