The clinical impact of upper airway resistance syndrome (UARS) continues to be debated. Reports suggest increased post-operative complications in those with untreated obstructive sleep apnea (OSA). Due to pathophysiologic similarities between UARS and OSA, we hypothesized that those with UARS would have increased complications and longer hospital length-of-stay (LOS) after bariatric surgery.
We retrospectively reviewed all patients who underwent bariatric surgery and attended pre-operative overnight polysomnogram (PSG) at our institution between January and November of 2004. UARS was defined as greater than 10 respiratory-related arousals per hour of sleep with an apnea-hypopnea index less than 5. Among 285 bariatric surgeries, 156 underwent PSGs. Among these patients, 33 had UARS and 15 had normal polysomnogram results (normal controls). We subsequently compared complication rates, and hospital and intensive care unit (ICU) LOS between the two groups. We also compared the results within the UARS group between those who received continuous positive airway pressure (CPAP) versus those who did not.
Most subjects were female and there were no statistical differences in the mean age or body mass index (45.3 ± 5.9 kg/m2 versus 48.3 ± 10 kg/m2, p=0.29) between the two groups. There was no statistical difference in the hospital LOS (5.4 ± 2.3 vs 5.7 ± 2.3 days), but more patients in the UARS group spent days in the ICU (26/33 vs 7/15) and the ICU LOS was significantly higher in the UARS group (1.12 ± 0.97 vs 0.63 ± 0.77 days, p=0.03). There were no significant differences in the frequency of complications between the two groups (24% vs 20%) or in complication rates among UARS patients that received CPAP and those that did not.
UARS does not appear to contribute to increases in complications or total LOS in the hospital after bariatric surgery. CPAP use during recovery did not seem to significantly impact the outcome of bariatric surgery in those with UARS.
Aggressive peri-operative treatment of UARS may not be imperative in bariatric surgery.
John Park, None.