Subjective sleepiness and daytime functioning in bariatric patients with obstructive sleep apnea
- First Online:
- 280 Downloads
The purpose of this study was to evaluate associations between obstructive sleep apnea (OSA) severity and self-reported sleepiness and daytime functioning in patients considering bariatric surgery for treatment of obesity.
Using a retrospective cohort design, we identified 342 patients who had sleep evaluations prior to bariatric surgery. Our final sample included 269 patients (78.6 % of the original cohort, 239 females; mean age = 42.0 ± 9.5 years; body mass index = 50.2 ± 7.7 kg/m2) who had overnight polysomnography and completed the Epworth Sleepiness Scale (ESS) and the Functional Outcomes of Sleep Questionnaire (FOSQ). Patients' OSA was classified as none/mild (apnea–hypopnea index (AHI) < 15, n = 112), moderate (15 ≤ AHI < 30, n = 77), or severe (AHI ≥ 30, n = 80). We calculated the proportion of unique variance (PUV) for the five FOSQ subscales. ANOVA was used to determine if ESS and FOSQ were associated with OSA severity. Unpaired t tests compared ESS and FOSQ scores in our sample with published data.
The average AHI was 29.5 ± 31.5 events per hour (range = 0–175.8). The mean ESS score was 6.3 ± 4.8, and the mean global FOSQ score was 100.3 ± 18.2. PUVs for FOSQ subscales showed moderate-to-high unique contributions to FOSQ variance. ESS and global FOSQ score did not differ by AHI group. Only the FOSQ vigilance subscale differed by OSA severity with the severe group reporting more impairment than the moderate and none/mild groups. Our sample reported less sleepiness and daytime impairment than previously reported means in patients and controls.
Subjective sleepiness and functional impairment were not associated significantly with OSA severity in our sample of patients considering surgery for obesity. Further research is needed to understand individual differences in sleepiness in patients with OSA. If bariatric patients underreport symptoms, self-report measures are not an adequate substitute for objective assessment and clinical judgment when evaluating bariatric patients for OSA. Patients with severe obesity need evaluation for OSA even in the absence of subjective complaints.
KeywordsSleepiness Obstructive sleep apnea Obesity Bariatric surgery Epworth Sleepiness Scale Functional Outcomes of Sleep Questionnaire Sex differences
- 6.Carneiro G, Florio RT, Zanella MT, Pradella-Hallinan M, Ribeiro-Filho FF, Tufik S, Togeiro SM (2011) Is mandatory screening for obstructive sleep apnea with polysomnography in all severely obese patients indicated? Sleep Breath. doi:10.1007/s11325-010-0468-7
- 11.Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Cote CJ, Nickinovich DG, Prachand V, Ward DS, Weaver EM, Ydens L, Yu S (2006) Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 104:1081–1093PubMedCrossRefGoogle Scholar
- 14.Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A, McCloskey C, Mitchell J, Patterson E, Pomp A, Staten MA, Yanovski SZ, Thirlby R, Wolfe B (2009) Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 361:445–454PubMedCrossRefGoogle Scholar
- 25.Pan A, Sun Q, Czernichow S, Kivimaki M, Okereke OI, Lucas M, Manson JE, Ascherio A, Hu FB (2011) Bidirectional association between depression and obesity in middle-aged and older women. Int J Obes (Lond). doi:10.1038/ijo.2011.111
- 26.Cameron AJ, Magliano DJ, Dunstan DW, Zimmet PZ, Hesketh K, Peeters A, Shaw JE (2011) A bi-directional relationship between obesity and health-related quality of life: evidence from the longitudinal AusDiab study. Int J Obes (Lond). doi:10.1038/ijo.2011.103
- 30.Granger C (1984) A conceptual model for functional assessment. In: Granger C, Gresham G (eds) Functional assessment in rehabilitation medicine. Williams and Wilkins, Baltimore, pp 14–25Google Scholar
- 33.Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques, and scoring system for sleep stages in human subjects. UCLA Brain Information Service/Brain Research Institute, Los AngelesGoogle Scholar
- 34.American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Report of the American Academy of Sleep Medicine Task Force. Sleep 22:667–689Google Scholar
- 35.American Academy of Sleep Medicine (1992) EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15:173–184Google Scholar
- 46.Cruz IA, Drummond M, Winck JC (2011) Obstructive sleep apnea symptoms beyond sleepiness and snoring: effects of nasal APAP therapy. Sleep Breath. doi:10.1007/s11325-011-0502-4