Potentially life-threatening sleep apnea is unrecognized without aggressive evaluation.

Background: Many patients undergoing bariatric surgery have severe comorbidities, including obstructive sleep apnea (OSA). We suspected that sleep apnea was underdiagnosed in our study population.

Methods: A retrospective chart review of our bariatric database was conducted comparing OSA evaluation based on clinical parameters (Era 1) with mandatory OSA evaluation for all patients (Era 2).

Results: In both Era groups approximately 19% of patients presented to our program with an established diagnosis of OSA. In Era 1 this increased to 56% based on clinical parameters and in Era 2 this increased to 91% with mandatory polysomnography testing of all patients.

Conclusions: OSA is grossly underdiagnosed in patients with morbid obesity presenting for bariatric surgery. Clinical evaluation continues to miss a substantial percentage of patients with OSA. Mandatory testing of all patients for OSA with polysomnography before bariatric surgery is recommended.