Excess daytime sleepiness, daily functioning and health-related quality of life during the first year after metabolic and bariatric surgery in patients with a known and unknown obstructive sleep apnea status

Purpose Despite a high prevalence of obstructive sleep apnea (OSA) in patients undergoing metabolic and bariatric surgery (MBS), there is no consensus on the best perioperative OSA strategy. Supplemental oxygen therapy without pre-operative OSA-testing (pulse oximetry) is safe and more cost-effective compared to preoperative OSA-testing using poly(somno)graphy (sleep test). This study aimed to compare these strategies on excess daytime sleepiness (EDS), its impact on daily functioning and health-related quality of life (HRQoL). Methods Multicenter prospective cohort study including 1388 patients, 691 in the sleep test and 697 in the pulse oximetry group based on local protocols. EDS (ESS), its impact on daily functioning (FOSQ-10), HRQoL (RAND-36) and total weight loss (TWL) were assessed preoperatively and 1, 3, 6 and 12 months postoperatively. (Sub)scores were compared over time between and within groups using linear mixed models. Results No differences between the pulse oximetry and sleep test strategy were found in EDS, its influence on daily life and HRQoL, and all improved after MBS. In the pulse oximetry group a lower TWL was found 1 month postoperative (-0.7%). Conclusion Considering that pulse oximetry is more cost-effective, equally safe and comparable in EDS, its effect on daily functioning and HRQoL and no clinically relevant difference in TWL was found compared to the sleep test strategy, this study lends further support for pulse oximetry being the best strategy for managing OSA in patients undergoing MBS.