Preoperative screening for obstructive sleep apnea in morbidly obese patients.
In the western world, obesity is considered a key health problem. It has been estimated that more than two thirds of North Americans are overweight or obese and almost 34% of adults and 15% to 20% of children and adolescents of the US population are obese. Obesity has long been recognized as a predecessor of morbidity and premature mortality. It is frequently associated with a higher incidence of hypertension, lethal cardiac dysrhythmia, ischemic heart disease, and premature coronary death. Other related medical problems include hyperglycemia, diabetes mellitus, dyslipidemia, gall bladder disease, nonalcoholic fatty liver disease, stroke, degenerative joint disease, and obstructive sleep apnea (OSA). In addition to a poor quality of life; obesity is associated with hormonal changes that can lead to an increased likelihood of malignant tumors. Uterine and breast tumors have been documented in obese females. Similarly, a higher incidence of renal and esophageal carcinoma is reported in obese males compared to the normal weight population. Data showed that obesity was responsible for 365,000 preventable deaths in 2000. Given the increasing risk with comorbidity, the standard definition of morbid obesity was modified to incorporate patients of body mass index (BMI)Z35 kg/m with concomitant obesity-related disease. One of the major health care expenditures in the coming 2 decades will be the treatment of metabolic disease associated with obesity. With the increased life expectancy and