Abstract
Background Obesity is an increasing problem, 31% of children being obese or overweight. Obesity increases the risk of obstructive sleep apnoea (OSA), is linked to lower lung volumes and restrictive lung disease. Children who are morbidly obese are at such high risk of co-morbidities that bariatric surgery is performed at King's College Hospital, with excellent success.
Aims We aim to perform respiratory assessments prior to bariatric surgery, to ensure that children are safe for the procedure, and to check for treatable respiratory co-morbidities.
Methods We have performed respiratory assessments prior to bariatric surgery in 11 children (5 male) under 19 years. The mean BMI was 50 (31.8-62.6). The assessment includes a sleep history, sleep study, and spirometry.
Results Three patients had moderate-severe sleep disordered breathing prior to surgery, and were commenced on CPAP. A mean BMI reduction of -9.2 and mean weight loss of -19 Kg, 8 months following surgery was seen. One patient was able to stop CPAP post operatively due to significant weight loss.
BMI (Kg/m2) | 50 (31.8-62.6) |
Mean nocturnal saturations (%) | 96 (93-98) |
Nocturnal 3% oxygen desaturation index (/hour) | 5.39 (0.56-31.7) |
Nocturnal saturation nadir (%) | 89 (79-93) |
Nocturnal mean CO2 (KPa) | 5.79 (5.19-7.08) |
Nocturnal peak CO2 (KPa) | 6.7 (5.8-8.1) |
Time> 6.5KPa (%) | 2.26 (0-92.5) |
FEV1 (% predicted) | 108 (104-169) |
FVC (% predicted) | 119 (98-164) |
All median (range).
Conclusions Morbidly obese paediatric patients listed for bariatric surgery have a high incidence of OSA, a respiratory assessment is essential pre-operatively, so that treatment can be instituted prior to surgery.
- Copyright ©the authors 2016