• de Raaff Christel A L CAL Department of Surgery, OLVG West, Amsterdam, the Netherlands. Electronic address: c.deraaff@olvg.nl., Marguerite A W Gorter-Stam, Nico de Vries, Ashish C Sinha, Jaap Bonjer H H Department of Surgery, VU Medical Center, Amsterdam, the Netherlands., Frances Chung, Usha K Coblijn, Albert Dahan, Rick S van den Helder, Hilgevoord Antonius A J AAJ Department of Clinical Neurophysiology, OLVG West, Amsterdam, the Netherlands., David R Hillman, Michael P Margarson, Samer G Mattar, Jan P Mulier, Ravesloot Madeline J L MJL Department of Otorhinolaryngology, OLVG West, Amsterdam, the Netherlands., Reiber Beata M M BMM Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands., Anne-Sophie van Rijswijk, Preet Mohinder Singh, Roos Steenhuis, Mark Tenhagen, Olivier M Vanderveken, Johan Verbraecken, David P White, Nicole van der Wielen, and Bart A van Wagensveld.
• Department of Surgery, OLVG West, Amsterdam, the Netherlands. Electronic address: c.deraaff@olvg.nl.
• Surg Obes Relat Dis. 2017 Jul 1; 13 (7): 1095-1109.

BackgroundThe frequency of metabolic and bariatric surgery (MBS) is increasing worldwide, with over 500,000 cases performed every year. Obstructive sleep apnea (OSA) is present in 35%-94% of MBS patients. Nevertheless, consensus regarding the perioperative management of OSA in MBS patients is not established.ObjectivesTo provide consensus based guidelines utilizing current literature and, when in the absence of supporting clinical data, expert opinion by organizing a consensus meeting of experts from relevant specialties.SettingThe meeting was held in Amsterdam, the Netherlands.MethodsA panel of 15 international experts identified 75 questions covering preoperative screening, treatment, postoperative monitoring, anesthetic care and follow-up. Six researchers reviewed the literature systematically. During this meeting, the "Amsterdam Delphi Method" was utilized including controlled acquisition of feedback, aggregation of responses and iteration.ResultsRecommendations or statements were provided for 58 questions. In the judgment of the experts, 17 questions provided no additional useful information and it was agreed to exclude them. With the exception of 3 recommendations (64%, 66%, and 66% respectively), consensus (>70%) was reached for 55 statements and recommendations. Several highlights: polysomnography is the gold standard for diagnosing OSA; continuous positive airway pressure is recommended for all patients with moderate and severe OSA; OSA patients should be continuously monitored with pulse oximetry in the early postoperative period; perioperative usage of sedatives and opioids should be minimized.ConclusionThis first international expert meeting provided 58 statements and recommendations for a clinical consensus guideline regarding the perioperative management of OSA patients undergoing MBS.Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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