Prevalence and Prediction of Obstructive Sleep Apnea Prior to Bariatric Surgery—Gender-Specific Performance of Four Sleep Questionnaires
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Bariatric surgery (BS) is a treatment option for morbid obesity leading to substantial and sustained weight loss in adults. As obstructive sleep apnea (OSA) is highly prevalent in obese subjects and may increase the perioperative risk, screening for OSA is recommended prior to BS. In clinical routine, BS is performed more frequently in women. Therefore, we sought to assess the gender-specific performance of four sleep questionnaires (Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), STOPBang, and NoSAS) to predict moderate to severe OSA in the morbidly obese population.
Material and Methods
We applied all four questionnaires to patients scheduled for BS with polygraphic OSA screening at our institution between 2012 and 2015 and performed gender-specific sensitivity analyses.
We included 251 bariatric patients (76% female, median age 39 years, median BMI 42.0 kg/m2). OSA (AHI > 5/h; AHI > 15/h) was present in 43% (females 35%, males 68%; p < 0.001) and 21% (females 13%, males 45%; p < 0.001). STOPBang and NoSAS performed markedly better than ESS and FSS. With the exception of the ESS, all sleep questionnaires allowed better OSA prediction in women than in men.
In obese patients scheduled for BS, a gender-specific difference was observed in the performance of the evaluated OSA screening questionnaires. This needs to be considered when these questionnaires are used. Our results underline the need for better gender-specific OSA screening algorithms in morbidly obese patients.
KeywordsObesity Bariatric surgery Sleep-disordered breathing Obstructive sleep apnea
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
This study was approved by the local ethics committee (KEK 2017-00772).
Due to the retrospective nature of the study, informed patient consent was waived.
- 3.Kolotkin RL, LaMonte MJ, Walker JM, et al. Predicting sleep apnea in bariatric surgery patients. Surg Obes Relat Dis. 7:605–10. https://doi.org/10.1016/jsoard201104.226.
- 4.Duarte RL de M, Magalhães-da-Silveira FJ. Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography. J Bras Pneumol publicaçao Of da Soc Bras Pneumol e Tisilogia. 2015;41:440–8. https://doi.org/10.1590/S1806-37132015000000027.CrossRefGoogle Scholar
- 6.Gross JB, Bachenberg KL, Benumof JL, et al. 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. 2006;104:1081–93–8.CrossRefGoogle Scholar
- 16.Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8:597–619. https://doi.org/10.5664/jcsm.2172. CrossRefPubMedPubMedCentralGoogle Scholar
- 18.R: The R Project for Statistical Computing. https://www.r-project.org/. Accessed 24 Apr 2016.