Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Pulmonary and Critical Care Division, Phramongkutklao Hospital, Bangkok, Thailand.
J Clin Sleep Med. 2022 Dec 1;18(12):2793-2801. 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, Bena J, et al. Obesity-associated sleep hypoventilation and increased adverse postoperative bariatric surgery outcomes in a large clinical retrospective cohort. . 2022;18(12):2793-2801.
肥胖低通气综合征（OHS）与发病率和死亡率增加有关，但由于对 OHS 的评估往往不系统，因此术后肥胖相关 OHS 的风险仍不清楚。
我们利用在多导睡眠监测期间进行夜间 CO 监测的临床队列来解决假设，即患有肥胖相关睡眠通气不足（OaSH；即，II 期 OHS）的患者术后接受减重手术的不良结局增加。我们回顾性分析了 2011 年至 2018 年在克利夫兰诊所接受减重手术多导睡眠监测的患者的数据。OaSH 通过 BMI≥30kg/m2 和以下任何一项确定：基于多导睡眠图的呼气末 CO≥45mmHg 或血清碳酸氢盐≥27mEq/L。考虑的结果如下：重症监护病房停留、插管、气管切开术、出院处置不是在家或 30 天再入院单独和作为一个组合，以及全因死亡率。使用两样本 t 检验或 Wilcoxon 秩和检验进行连续变量比较，使用卡方检验或 Fisher 精确检验进行分类变量比较。使用 Kaplan-Meier 估计和 Cox 比例风险模型比较全因死亡率。
分析样本（n=1665）年龄为 45.2±12 岁，20.4%为男性，BMI 为 48.7±9kg/m2，63.6%为白人。OaSH 的患病率为 68.5%。OaSH 患者年龄较大，更可能为男性，BMI、呼吸暂停低通气指数和糖化血红蛋白更高。OaSH 患者的复合结局高于非 OaSH 患者（18.9%对 14.3%，P=0.021）。尽管一些个别结果分别在 OaSH 患者中高于非 OaSH 患者，但差异无统计学意义：插管（1.5%对 1.3%，P=0.81）和 30 天再入院（13.8%对 11.3%，P=0.16）。两组之间的长期死亡率（中位随访时间：22.9 个月）无显著差异，这可能是由于总体事件发生率较低（风险比=1.39，95%置信区间：0.56，3.42）。
在这项迄今为止对减重手术队列中系统性表型 OaSH 的最大样本研究中，我们发现 II 期 OHS 中睡眠相关通气不足的患者术后发病率增加，如果考虑复合结局，但插管、重症监护病房入院和住院时间的个别因素并未增加。需要进一步研究以确定围手术期治疗 OaSH 是否可以改善减重手术后的结局。
Chindamporn P, Wang L, Bena J, et al. Obesity-associated sleep hypoventilation and increased adverse postoperative bariatric surgery outcomes in a large clinical retrospective cohort.. 2022;18(12):2793-2801.
