Why is sleep apnea a concern with bariatric (or any) surgery? And what role does having a CPAP machine brought to the hospital have? Aren't oxygen levels etc closely monitored in the hospital anyway, especially if it is not none that a patient might have sleep apnea?
Hello again,Sleep apnea is a disease process where patients have problems with their arway staying open during sleep. This causes a functional airway obstruction that results in patients getting less oxygen delivered to their lungs. For postoperative surgical patients with a history of sleep apnea, the anesthesiologists normally recommend they bring their CPAP machines from home, to help keep their airway open as they are waking up from anesthesia. There is a 1-2 hour period after surgery where patients are breathing on their own, but the anesthesia and pain medication has not yet worn off completely. It is during this period of time of decreased awareness where patients are at greatest risk of suffering breathing breathing problems after surgery. The CPAP mask can be critical in patients with sleep apnea, as it helps keep the airway open and deliver oxygen to the patient.For patients having certain kinds of surgery, the CPAP can potentially cause problems. This is especially true for sleeve gastrectomy and gastric bypass patients. The CPAP machine blows air/oxygen into the patients upper airway, helping to keep the passages open and deliver oxygen efficiently. It also blows air into the upper digestive system, including the esophagus and stomach. Since this air is under pressure, and also taking into consideration that the stomach doesn't empty very well right after surgery, a whole lot of air can collect in the stomach. With sleeve/bypass patients, this air, under pressure in the stomach/pouch, can create a leak at the staple line (sleeve) or anastomosis (bypass). Many bariatric surgeons do not allow their sleeve and bypass patients to use CPAP for a week or more after surgery, for this reason alone.This brings up your final question. Yes, patients are monitored closely after surgery to make sure they are breathing, and No, the CPAP mask isn't critical at all. CPAP makes for a safer recovery for most patients, but as I described above, it isn't the correct solution for postoperative oxygenation for all situations.Take care,Dr. Dan
ASMBS Centers of Excellence Bariatric Surgeon
Appreciate this information. I will ask my surgeon if he requires this. If he does, should I be concerned and perhaps seek a different surgeon? Last thing I would want is a leak. I am not as yet using a CPAP or BiPAP machine because there is some question (on my part) as to the results of the sleep center study versus the at home study. What is the advantage/benefits of using a CPAP/BiPAP weeks before surgery? Are there accumulative benefits?
Hi,Since you are new to this potential diagnosis, then there is really no benefit to starting CPAP before surgery, despite what pulmonologists may say. My opinion about CPAP use immediately after bypass or sleeve gastrectomy is currently a topic of debate amongst bariatric surgeons. There is currently no consensus statement from the ASMBS on the matter of CPAP in immediate postoperative period, and they leave it to the discretion of the surgeon. The translation on that is that there is anecdotal evidence showing CPAp may be harmful, but no good data proving it exists. If you are statistically savvy, it would be considered a 2b recommendation.With that said, I woul not seek a new bariatric surgeon I s/he is pushing for postoperative CPAP usage. My take on the matter is that the minimal benefit it provides does not outweighs the potential adverse risk, so I don't use it.To answer the other part of your question, the benefit of CPAP is that patients feel more rested and have more energy when they have sleep apnea and use CPAP. This can improve the patient's immune system, which can help with wound healing after surgery. However, if your diagnosis is in question to begin with, any preoperative benefit you may enjoy would likely be insignificant. Patients in a similar situation to yours I have recommended that they wait until a couple weeks after surgery, repeat the sleep study, and pursue CPAP only if the repeat study is convincing for sleep apnea.Hope that helps!Dr Dan
Thanks again. What if the diagnosis of sleep apnea is confirmed, would there then be a benefit of being on CPAP prior to surgery?
Do I have any recourse if I do not want to use CPAP immediately after surgery (if in fact sleep apnea is diagnosed)? Or is it that the surgeon's directives outweigh a patient's preference?
There is a benefit to starting CPAP before surgery, as being well-rested is good for your immune system. With that said, I don't insist patients with a new diagnosis start it before surgery. If you don't tolerate sleeping with your mask, or you don't want to incur the expense of obtaining the equipment, just discuss your rationale with your surgeon. On the spectrum of potential problems before surgery, sleep apnea is pretty low on that danger scale. Your surgeon will likely not fuss too much over the matter. After surgery, you will be losing weight fast enough that the sleep apnea will likely resolve within weeks to a few months. If you still find yourself with unrestful sleep after recovering from surgery, to the point that you are dozing off while driving, then you should reconsider the CPAP. However, most patients don't seem to have problems once they lose weight. Good luck,Dr Dan
Okay, I will bring this up with the surgeon once I consult with the pulmonologist. I have never complained of tiredness during the day, I do not have restless sleep, I simply have no apparent symptoms of apnea. That being said, if I have sleep apnea I will take it seriously as I believe it is a serious condition. Thank you for your response and the information you provide.
You are welcome!