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Screening Questionnaires for Obstructive Sleep Apnea in patients evaluated for Bariatric Surgery
Obstructive Sleep Apnea (OSA) affects nearly 1 billion people worldwide and obesity is its main reversible risk factor. Bariatric surgery is the most effective and long-lasting treatment for morbid obesity. As untreated OSA increases the frequency of perioperative complications, screening for OSA prior to bariatric surgery has been recommended. Polysomnography is the gold standard method for diagnosis and, although there are OSA clinical screening assessment tools, a key knowledge gap is identifying which tools are most clinically relevant to use in clinical practice models.
The aim of this study is to evaluate three standardized screening questionnaires to identify high-risk patients for OSA among patients undergoing bariatric surgery.
Consecutive obese patients evaluated for bariatric surgery from August 2018 to August 2019 underwent clinical screening with STOP-BANG, NoSAS and Epworth Sleepinesse Scale (ESS) and a standard overnight polysomnography (PSG) at a sleep study center. Evaluation and interpretation of the PSG followed the American Society of Sleep Medicine criteria (2.5). Inclusion criteria included age > 18 years and a body mass index (BMI) > 30 kg/m2. Exclusion criteria included a previous diagnosis of OSA and incomplete data.
112 subjects were analyzed. The mean age was 36.1 ± 9.4 (range = 18–63) and 83% were female. The prevalence of OSA and moderate to severe OSA were 77.7 and 40.2%, respectively. The frequency of subjects who were classified as high risk by the NoSAS was 41.1% and by the STOP-BANG was 52.7%. The NoSAS score identified individuals at risk of moderate to severe OSA, with an area under the curve (AUC) of 0·67 (95% CI 0·56–0·77; p=0,003). Stop-BANG questionnaire identified individuals at risk of clinically significant OSA, with an AUC of 0·71 (95% CI 0·61–0·81; p<0,001). ESS score was not predictive of moderate to severe OSA, with an area under the curve (AUC) of 0·54 (95% CI 0·43–0·65; p=0,4). The sensitivity and specificity values of the NoSAS score to predict moderate to severe OSA were 53.3 and 67.2%, respectively. The sensitivity and specificity values of STOP-BANG to predict moderate to severe OSA were 71.1 and 59.7%, respectively.
In obese patients evaluated for bariatric surgery, STOP-BANG questionnaire performed better than NoSAS score and ESS to identify patients with moderate to severe OSA, although neither screening tool seemed able to replace the need for polysomnography.
Sleep apnea; Bariatric surgery; STOP-BANG
Everton Vieira Lopes Silva, Michele Ferreira Lino Rocha, Letícia Góes Gitaí Fernandes, Paulo Victor Lima, Victor Cardoso Rocha, Jorge Artur Peçanha Miranda Coelho, Bruno Rocha Mota, Lívia Leite Góes Gitaí