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Critical evaluation of screening questionnaires for obstructive sleep apnea in patients undergoing coronary artery bypass grafting and abdominal surgery

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Abstract

Background

Obstructive sleep apnea (OSA) is an independent risk factor for complications after surgery. However, OSA remains largely under recognized, and questionnaires designed to detect OSA have shown inconsistent results. Patients with cardiovascular diseases may not present with the typical symptoms of OSA. We therefore sought to compare the performance of screening questionnaires of patients referred for coronary artery bypass grafting (CABG) versus abdominal surgery (Abd surgery).

Methods

We studied 40 consecutive patients referred for CABG [29 men; age 56 ± 7 years; body mass index (BMI) 30 ± 4 kg/m2], and 41 referred to Abd Surgery matched for age, gender, and BMI (28 men; age 56 ± 8 years; BMI 29 ± 5 kg/m2). All patients were evaluated with validated questionnaires to predict OSA (STOP-Bang and Berlin), Epworth sleepiness scale (ESS) and full overnight polysomnography.

Results

The prevalence of OSA (apnea-hypopnea index ≥15 events/hour) in the CABG and Abd surgery groups was similar (52 and 41 %, respectively, p = 0.32). The Berlin questionnaire showed similar sensitivity (67 vs. 82 %, p = 0.17) but lower specificity in the CABG group (26 vs. 62 %, p = 0.02). The STOP-BANG questionnaire had a high sensitivity (90 vs. 94 %, p = 0.42) but low specificity (5 vs. 13 %, p = 0.25) in the CABG and Abd surgery groups, respectively. Patients referred for CABG slept less (323 [285–376] vs. 378 [308–415] minutes, p = 0.04) but had lower levels of daytime sleepiness than Abd surgery patients had (ESS, 6 ± 4 vs. 9 ± 5; p = 0.01, respectively).

Conclusions

Presenting clinical characteristics of OSA are modulated by the population evaluated and may affect the performance of screening questionnaires.

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Acknowledgements

We acknowledged the help of professionals from the Sleep Laboratory of Heart Institute (InCor), University of São Paulo Medical School, for the help in the conduct of the study.

Conflict of interest

None declared.

Funding

This work was supported by institutional funding only provided by FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo).

Author information

Authors and Affiliations

  1. Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas Carvalho de Aguiar, 44, 05403-904, São Paulo, Brazil

    Flavia S. Nunes, Pedro R. Genta & Geraldo Lorenzi-Filho

  2. Nursing Division, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas Carvalho de Aguiar, 44, 05403-904, São Paulo, Brazil

    Naury J. Danzi-Soares

  3. Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas Carvalho de Aguiar, 44, 05403-904, São Paulo, Brazil

    Luciano F. Drager

  4. Chronic Coronariopathy Unit, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas Carvalho de Aguiar, 44, 05403-904, São Paulo, Brazil

    Luiz A.M. Cesar

Authors
  1. Flavia S. Nunes
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  2. Naury J. Danzi-Soares
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  3. Pedro R. Genta
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  6. Geraldo Lorenzi-Filho
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Correspondence to Flavia S. Nunes.

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Nunes, F.S., Danzi-Soares, N.J., Genta, P.R. et al. Critical evaluation of screening questionnaires for obstructive sleep apnea in patients undergoing coronary artery bypass grafting and abdominal surgery. Sleep Breath 19, 115–122 (2015). https://doi.org/10.1007/s11325-014-0971-3

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  • DOI: https://doi.org/10.1007/s11325-014-0971-3

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