Comparative performance of screening instruments for obstructive sleep apnea in morbidly obese patients referred to a sleep laboratory: a prospective cross-sectional study

  • Ricardo L. M. DuarteEmail author
  • Fernanda C. Q. Mello
  • Flavio J. Magalhães-da-Silveira
  • Tiago S. Oliveira-e-Sá
  • Marcelo F. Rabahi
  • David Gozal
Sleep Breathing Physiology and Disorders • Original Article



Obstructive sleep apnea (OSA) is very common occurrence among morbidly obese patients. Our main objectives were to validate the No-Apnea, a 2-item screening tool, in morbidly obese patients and compare its performance with three other instruments: STOP-Bang questionnaire, NoSAS score, and Epworth Sleepiness Scale (ESS).


A cross-sectional analysis of morbidly obese patients (body mass index [BMI] ≥ 35.0 kg/m2) grouped into two independent samples: bariatric surgery patients (BS) and non-bariatric surgery patients (NBS). All patients underwent overnight polysomnography. Discriminatory ability was assessed by area under the curve (AUC). OSA severity was defined by apnea/hypopnea index cut-off points: ≥ 5.0/h (OSA≥5), ≥ 15.0/h (OSA≥15), and ≥ 30.0/h (OSA≥30).


A total of 1017 subjects (40.4% in BS cohort and 59.6% in NBS cohort) were evaluated. In the BS cohort, No-Apnea had similar discrimination to STOP-Bang and NoSAS for predicting OSA≥5 (p = 0.979 and p = 0.358, respectively), OSA≥15 (p = 0.158 and p = 0.399, respectively), and OSA≥30 (p = 0.388 and p = 0.903, respectively). In the NBS cohort, No-Apnea had similar discrimination to STOP-Bang and NoSAS for predicting OSA≥5 (p = 0.528 and p = 0.428, respectively), OSA≥15 (p = 0.825 and p = 0.108, respectively), and OSA≥30 (p = 0.458 and p = 0.186, respectively). Moreover, No-Apnea performed significantly better than ESS in both BS and NBS cohorts (p < 0.001).


No-Apnea is a useful and practical tool for screening of OSA in morbidly obese patients, with non-inferior performance to STOP-Bang questionnaire and NoSAS score.


Obstructive sleep apnea Polysomnography Screening Obesity 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The authors declare that the protocol of the research work was approved by the Ethics Commission of the Universidade Federal do Rio de Janeiro (UFRJ) according to the Helsinki Declaration, and all the patients provided written informed consent.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Sleep - Laboratório de Estudo dos Distúrbios do Sono, Centro Médico BarraShoppingRio de JaneiroBrazil
  2. 2.Instituto de Doenças do Tórax - Universidade Federal do Rio de JaneiroRio de JaneiroBrazil
  3. 3.Hospital de Santa Marta - Centro Hospitalar Lisboa CentralLisbonPortugal
  4. 4.NOVA Medical School - Faculdade de Ciências MédicasUniversidade Nova de LisboaLisbonPortugal
  5. 5.Faculdade de MedicinaUniversidade Federal de GoiásGoiásBrazil
  6. 6.Department of Child HealthUniversity of Missouri School of MedicineColumbiaUSA

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