Advertisement

Sleep-Disordered Breathing and Bariatric Surgery

  • Michael V. J. Braganza
  • Stephen K. FieldEmail author
Chapter
  • 45 Downloads

Abstract

Obesity has both mechanical and physiologic effects on the respiratory system. These effects can manifest clinically as dyspnea and decreased exercise capacity. The pathophysiological changes of obesity are reflected in the pulmonary function tests (PFT). Obstructive sleep apnea (OSA) is a common obesity-related pathology. Its prevalence has increased in parallel with the worldwide obesity epidemic. Its pathophysiology is complex and incompletely understood. OSA is overrepresented in bariatric surgery patients, but it is often unrecognized. It may be associated with daytime fatigue, decreased mental acuity, and depression. It increases the risk of occupation-related accidents. Over the long term, it is associated with increased cardiovascular risks. The bariatric clinician should maintain a high index of suspicion for OSA because of its associated perioperative risks. Diagnostic evaluation of bariatric surgery candidates should be undertaken to determine whether it is present. Continuous positive airway pressure (CPAP) is the gold standard for therapy. Bariatric surgery has been successful in improving lung function and treating OSA. Most patients, however, will not experience complete resolution of OSA even with weight loss after successful surgery.

Keywords

Obstructive sleep apnea (OSA) Obesity hypoventilation syndrome (OHS) Central sleep apnea (CSA) Cheyne-Stokes respiration Morbid obesity Bariatric surgery Chest wall restriction Pulmonary function test Polysomnogram Portable monitor 

References

  1. 1.
    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011–2012. NCHS Data Brief. 2013;131(131):1–8.Google Scholar
  2. 2.
    McClean KM, Kee F, Young IS, Elborn JS. Obesity and the lung: 1. Epidemiology. Thorax. 2008;63(7):649–54.CrossRefGoogle Scholar
  3. 3.
    WHO. Obesity and overweight internet. http://www.who.int/mediacentre/factsheets/fs311/en/2016
  4. 4.
    Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. J Appl Physiol (1985). 2010;108(1):206–11.CrossRefGoogle Scholar
  5. 5.
    Biring MS, Lewis MI, Liu JT, Mohsenifar Z. Pulmonary physiologic changes of morbid obesity. Am J Med Sci. 1999;318(5):293–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Chen Y, Rennie D, Cormier YF, Dosman J. Waist circumference is associated with pulmonary function in normal-weight, overweight, and obese subjects. Am J Clin Nutr. 2007;85(1):35–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Pelosi P, Croci M, Ravagnan I, Tredici S, Pedoto A, Lissoni A, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg. 1998;87(3):654–60.PubMedGoogle Scholar
  8. 8.
    Sood A. Altered resting and exercise respiratory physiology in obesity. Clin Chest Med. 2009;30(3):445–54, vii.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47–112.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Gifford AH, Leiter JC, Manning HL. Respiratory function in an obese patient with sleep-disordered breathing. Chest. 2010;138(3):704–15.PubMedCrossRefGoogle Scholar
  11. 11.
    Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest. 2006;130(3):827–33.PubMedCrossRefGoogle Scholar
  12. 12.
    Littleton SW. Impact of obesity on respiratory function. Respirology. 2012;17(1):43–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Parameswaran K, Todd DC, Soth M. Altered respiratory physiology in obesity. Can Respir J. 2006;13(4):203–10.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Thomas PS, Cowen ER, Hulands G, Milledge JS. Respiratory function in the morbidly obese before and after weight loss. Thorax. 1989;44(5):382–6.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Naimark A, Cherniack RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960;15:377–82.PubMedCrossRefGoogle Scholar
  16. 16.
    Sharp JT, Henry JP, Sweany SK, Meadows WR, Pietras RJ. The total work of breathing in normal and obese men. J Clin Invest. 1964;43:728–39.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Hedenstierna G, Santesson J. Breathing mechanics, dead space and gas exchange in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaesthesiol Scand. 1976;20(3):248–54.PubMedCrossRefGoogle Scholar
  18. 18.
    Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest. 1996;109(1):144–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Suratt PM, Wilhoit SC, Hsiao HS, Atkinson RL, Rochester DF. Compliance of chest wall in obese subjects. J Appl Physiol Respir Environ Exerc Physiol. 1984;57(2):403–7.PubMedGoogle Scholar
  20. 20.
    Sampson MG, Grassino AE. Load compensation in obese patients during quiet tidal breathing. J Appl Physiol Respir Environ Exerc Physiol. 1983;55(4):1269–76.PubMedPubMedCentralGoogle Scholar
  21. 21.
    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.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Mokhlesi B, Kryger MH, Grunstein RR. Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc. 2008;5(2):218–25.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Sugerman HJ, Fairman RP, Baron PL, Kwentus JA. Gastric surgery for respiratory insufficiency of obesity. Chest. 1986;90(1):81–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Mokhlesi B. Obesity hypoventilation syndrome: a state-of-the-art review. Respir Care. 2010;55(10):1347–62; discussion 63–5.PubMedGoogle Scholar
  26. 26.
    DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3(2):134–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Flemons WW. Clinical practice. Obstructive sleep apnea. N Engl J Med. 2002;347(7):498–504.PubMedCrossRefGoogle Scholar
  29. 29.
    Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–76.PubMedCrossRefGoogle Scholar
  30. 30.
    Orem J, Lovering AT, Dunin-Barkowski W, Vidruk EH. Tonic activity in the respiratory system in wakefulness, NREM and REM sleep. Sleep. 2002;25(5):488–96.PubMedGoogle Scholar
  31. 31.
    Riad W, Chung F. Preoperative screening for obstructive sleep apnea in morbidly obese patients. Int Anesthesiol Clin. 2013;51(3):13–25.PubMedCrossRefGoogle Scholar
  32. 32.
    Fleetham J, Ayas N, Bradley D, Fitzpatrick M, Oliver TK, Morrison D, et al. Canadian Thoracic Society 2011 guideline update: diagnosis and treatment of sleep disordered breathing. Can Respir J. 2011;18(1):25–47.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Davis G, Patel JA, Gagne DJ. Pulmonary considerations in obesity and the bariatric surgical patient. Med Clin North Am. 2007;91(3):433–42, xi.PubMedCrossRefGoogle Scholar
  34. 34.
    Gami AS, Caples SM, Somers VK. Obesity and obstructive sleep apnea. Endocrinol Metab Clin N Am. 2003;32(4):869–94.CrossRefGoogle Scholar
  35. 35.
    Tregear S, Reston J, Schoelles K, Phillips B. Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med. 2009;5(6):573–81.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Ayas N, Skomro R, Blackman A, Curren K, Fitzpatrick M, Fleetham J, et al. Obstructive sleep apnea and driving: a Canadian Thoracic Society and Canadian Sleep Society position paper. Can Respir J. 2014;21(2):114–23.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol. 2008;52(8):686–717.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320(7233):479–82.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829–36.PubMedCrossRefGoogle Scholar
  40. 40.
    Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med. 2006;173(8):910–6.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Braga B, Poyares D, Cintra F, Guilleminault C, Cirenza C, Horbach S, et al. Sleep-disordered breathing and chronic atrial fibrillation. Sleep Med. 2009;10(2):212–6.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Needleman M, Calkins H. The role of obesity and sleep apnea in atrial fibrillation. Curr Opin Cardiol. 2011;26(1):40–5.PubMedCrossRefGoogle Scholar
  43. 43.
    Harbison J, O’Reilly P, McNicholas WT. Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: effects of nasal continuous positive airway pressure therapy. Chest. 2000;118(3):591–5.PubMedCrossRefGoogle Scholar
  44. 44.
    McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375(10):919–31.CrossRefGoogle Scholar
  45. 45.
    Peker Y, Hedner J, Kraiczi H, Loth S. Respiratory disturbance index: an independent predictor of mortality in coronary artery disease. Am J Respir Crit Care Med. 2000;162(1):81–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071–8.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Campos-Rodriguez F, Pena-Grinan N, Reyes-Nunez N, De la Cruz-Moron I, Perez-Ronchel J, De la Vega-Gallardo F, et al. Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure. Chest. 2005;128(2):624–33.PubMedCrossRefGoogle Scholar
  48. 48.
    Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O’Connor GT, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6(8):e1000132.  https://doi.org/10.1371/journal.pmed.1000132.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Berry RB, Gamaldo CE, Harding SM, Brooks R, Lloyd RM, Vaughn BV, et al. AASM scoring manual version 2.2 updates: new chapters for scoring infant sleep staging and home sleep apnea testing. J Clin Sleep Med. 2015;11(11):1253–4.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Strohl K, Wheatley J, Young T, Douglas N, Levy P, McNicholas W, Fleetham J, et al. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667–89.Google Scholar
  51. 51.
    Punjabi NM. COUNTERPOINT: is the apnea-hypopnea index the best way to quantify the severity of sleep-disordered breathing? No. Chest. 2016;149(1):16–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13(5):676–83.CrossRefGoogle Scholar
  53. 53.
    Ravesloot MJ, van Maanen JP, Hilgevoord AA, van Wagensveld BA, de Vries N. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. Eur Arch Otorhinolaryngol. 2012;269(7):1865–71.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Khan A, King WC, Patterson EJ, Laut J, Raum W, Courcoulas AP, et al. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Nuckton TJ, Glidden DV, Browner WS, Claman DM. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep. 2006;29(7):903–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Canadian Sleep S, Blackman A, McGregor C, Dales R, Driver HS, Dumov I, et al. Canadian Sleep Society/Canadian Thoracic Society position paper on the use of portable monitoring for the diagnosis of obstructive sleep apnea/hypopnea in adults. Can Respir J. 2010;17(5):229–32.CrossRefGoogle Scholar
  57. 57.
    Rotenberg B, George C, Sullivan K, Wong E. Wait times for sleep apnea care in Ontario: a multidisciplinary assessment. Can Respir J. 2010;17(4):170–4.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–21.PubMedCrossRefGoogle Scholar
  59. 59.
    Araghi MH, Chen YF, Jagielski A, Choudhury S, Banerjee D, Hussain S, et al. Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. Sleep. 2013;36(10):1553–62, 62A–62E.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993;147(4):887–95.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008;5(2):173–8.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Engleman HM, Wild MR. Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev. 2003;7(1):81–99.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefGoogle Scholar
  64. 64.
    Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med. 2009;122(6):535–42.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Sarkhosh K, Switzer NJ, El-Hadi M, Birch DW, Shi X, Karmali S. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg. 2013;23(3):414–23.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Ashrafian H, Toma T, Rowland SP, Harling L, Tan A, Efthimiou E, et al. Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? a systematic review and comparison of meta-analyses. Obes Surg. 2015;25(7):1239–50.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med. 2008;4(4):333–8.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Dixon JB, Schachter LM, O’Brien PE, Jones K, Grima M, Lambert G, et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;308(11):1142–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Pillar G, Peled R, Lavie P. Recurrence of sleep apnea without concomitant weight increase 7.5 years after weight reduction surgery. Chest. 1994;106(6):1702–4.PubMedCrossRefGoogle Scholar
  70. 70.
    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(6):897–906.PubMedCrossRefGoogle Scholar
  71. 71.
    Memtsoudis S, Liu SS, Ma Y, Chiu YL, Walz JM, Gaber-Baylis LK, et al. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg. 2011;112(1):113–21.PubMedCrossRefGoogle Scholar
  72. 72.
    Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO. Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the nationwide inpatient sample. Chest. 2013;144(3):903–14.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med. 1994;150(5 Pt 1):1279–85.PubMedCrossRefGoogle Scholar
  74. 74.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485–91.PubMedCrossRefGoogle Scholar
  75. 75.
    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812–21.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Weingarten TN, Flores AS, McKenzie JA, Nguyen LT, Robinson WB, Kinney TM, et al. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth. 2011;106(1):131–9.PubMedCrossRefGoogle Scholar
  77. 77.
    de Raaff CA, Coblijn UK, de Vries N, van Wagensveld BA. Is fear for postoperative cardiopulmonary complications after bariatric surgery in patients with obstructive sleep apnea justified? A systematic review. Am J Surg. 2016;211(4):793–801.PubMedCrossRefGoogle Scholar
  78. 78.
    Lopez PP, Stefan B, Schulman CI, Byers PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg. 2008;74(9):834–8.Google Scholar
  79. 79.
    O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004;14(1):23–6.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Rao A, Tey BH, Ramalingam G, Poh AG. Obstructive sleep apnoea (OSA) patterns in bariatric surgical practice and response of OSA to weight loss after laparoscopic adjustable gastric banding (LAGB). Ann Acad Med Singap. 2009;38(7):587–93.PubMedGoogle Scholar
  81. 81.
    Sareli AE, Cantor CR, Williams NN, Korus G, Raper SE, Pien G, et al. Obstructive sleep apnea in patients undergoing bariatric surgery – a tertiary center experience. Obes Surg. 2011;21(3):316–27.PubMedCrossRefGoogle Scholar
  82. 82.
    Catheline JM, Bihan H, Le Quang T, Sadoun D, Charniot JC, Onnen I, et al. Preoperative cardiac and pulmonary assessment in bariatric surgery. Obes Surg. 2008;18(3):271–7.PubMedCrossRefGoogle Scholar
  83. 83.
    Schumann R, Jones SB, Cooper B, Kelley SD, Bosch MV, Ortiz VE, et al. Update on best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery, 2004–2007. Obesity (Silver Spring). 2009;17(5):889–94.CrossRefGoogle Scholar
  84. 84.
    Kurrek MM, Cobourn C, Wojtasik Z, Kiss A, Dain SL. Morbidity in patients with or at high risk for obstructive sleep apnea after ambulatory laparoscopic gastric banding. Obes Surg. 2011;21(10):1494–8.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Macavei VM, Spurling KJ, Loft J, Makker HK. Diagnostic predictors of obesity-hypoventilation syndrome in patients suspected of having sleep disordered breathing. J Clin Sleep Med. 2013;9(9):879–84.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Memtsoudis SG, Stundner O, Rasul R, Chiu YL, Sun X, Ramachandran SK, et al. The impact of sleep apnea on postoperative utilization of resources and adverse outcomes. Anesth Analg. 2014;118(2):407–18.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    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(11):1842–51.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Vasquez TL, Hoddinott K. A potential complication of bi-level positive airway pressure after gastric bypass surgery. Obes Surg. 2004;14(2):282–4.PubMedCrossRefGoogle Scholar
  89. 89.
    Huerta S, DeShields S, Shpiner R, Li Z, Liu C, Sawicki M, et al. Safety and efficacy of postoperative continuous positive airway pressure to prevent pulmonary complications after Roux-en-Y gastric bypass. J Gastrointest Surg. 2002;6(3):354–8.PubMedCrossRefGoogle Scholar
  90. 90.
    Ramirez A, Lalor PF, Szomstein S, Rosenthal RJ. Continuous positive airway pressure in immediate postoperative period after laparoscopic Roux-en-Y gastric bypass: is it safe? Surg Obes Relat Dis. 2009;5(5):544–6.PubMedCrossRefGoogle Scholar
  91. 91.
    Jensen C, Tejirian T, Lewis C, Yadegar J, Dutson E, Mehran A. Postoperative CPAP and BiPAP use can be safely omitted after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(4):512–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Respirology, Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada

Personalised recommendations