None listed
Conditions
Brief summary
Obstructive sleep apnoea (OSA) is a sleep disorder where patients stop breathing or have extremely shallow breathing during sleep. Excess weight increases the risk of OSA. However, the majority of patients with OSA that present for weight loss surgery are unaware that they have OSA. The first aim of this study is to see how common it is for patients to present for weight loss surgery with undiagnosed OSA. Before their operation, patients will answer a questionnaire (STOP-BANG) and will undergo a home sleep test (ApneaLink). Continuous positive airway pressure (CPAP) is the preferred everyday treatment for OSA. However, it is unknown whether the application of CPAP prevents complications, following weight loss surgery. The other aims of this study are to see if auto-titrated CPAP (APAP), following weight loss surgery: 1. Decreases the number of times a patient stops breathing or has extremely shallow breathing during sleep; 2. Improves oxygen levels in the blood; and 3. Prevents complications. Following their operation, patients with moderate or severe OSA (diagnosed from their ApneaLink home sleep testing) will be randomised to either: 1. Control group a. Overnight ApneaLink monitoring b. Oxygen and OSA monitoring c. Additional oxygen if required 2. APAP group a. Overnight APAP b. Oxygen and OSA monitoring c. Additional oxygen if required The number of times per hour that a patient stops breathing or has extremely shallow breathing during sleep (i.e. AHI) will be compared between the control and APAP groups. The two groups will also be compared regarding their blood oxygen levels (SpO2), additional oxygen requirement and complications, such as unplanned admissions to critical care.
Interventions
Auto-titrated continuous positive airway pressure (APAP)
Continuous positive airway pressure (CPAP) is a machine that blows air through a mask while a patient is sleeping. The pressure of the air keeps the airway open and makes breathing easier during sleep. Continuous positive airway pressure (CPAP) is the treatment of choice for OSA in the general population as it improves snoring, sleep quality, daytime sleepiness and fatigue. However, it is unclear whether CPAP reduces the risk of complicat
Auto-titrated continuous positive airway pressure (APAP) Continuous positive airway pressure (CPAP) is a machine that blows air through a mask while a patient is sleeping. The pressure of the air keeps the airway open and makes breathing easier during sleep. Continuous positive airway pressure (CPAP) is the treatment of choice for OSA in the general population as it improves snoring, sleep quality, daytime sleepiness and fatigue. However, it is unclear whether CPAP reduces the risk of complications following weight loss surgery in people with OSA. Initially there were concerns that pressurised air would inflate the stomach and intestine following bariatric surgery but CPAP has not been shown to increase the risk of anastomotic disruption. Auto-titrated CPAP (APAP) is a type of CPAP. Flow is measured with every breath and the delivered pressure is adjusted to maintain an unobstructed airway. One advantage of using APAP, in the postoperative period, is that treatment can be started without prior CPAP titration. The time interval between a patient’s appointment at the anaesthetic preassessment clinic and their operation is usually very short. In most hospitals, it would be impossible to both diagnose OSA with polysomnography and optimise the patient’s CPAP setting in this short space of time. Furthermore, the preoperative CPAP setting may be insufficient in the immediate postoperative phase due to the administered perioperative sedatives and analgesics. APAP group will receive 1. Postopeartive APAP treatment on the night of surgery; 2. Continuous postoperative blood oxygen level/saturation (SpO2) monitoring on the night of surgery, i.e. routine practice; and 3. Supplemental oxygen if SpO2 is <90%, i.e. routine practice.
Sponsors
Christopher Wong
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients undergoing laparoscopic bariatric surgery at Joondalup Health Campus, Western Australia: 1. Without a formal diagnosis of OSA, or 2. With a formal diagnosis of OSA but not using CPAP therapy.
Exclusion criteria
Patients with a formal diagnosis of OSA and using CPAP therapy. Patients undergoing other types of bariatric surgery, e.g. open surgery, gastric band removal. Patient refusal.
Outcome results
None listed