The Evaluation of Screening Questionnaires for Obstructive Sleep Apnea to Identify High-Risk Obese Patients Undergoing Bariatric Surgery
- 272 Downloads
Obstructive sleep apnea (OSA) is extremely common among bariatric surgical candidates. Identifying those at risk for moderate to severe OSA is challenging. Testing all bariatric surgical candidates with a level 1 polysomnographic study is expensive and resource intensive. The aim of this study is to evaluate three standardized screening questionnaires that are utilized to identify high-risk patients for OSA undergoing bariatric surgery.
A retrospective review of data collected prospectively was undertaken on bariatric surgical patients who have not had a preexisting diagnosis of OSA. Each patient was subjected to the STOP BANG and Berlin Questionnaires as well as the Epworth Sleepiness Scale (ESS), after which a level 1 polysomnogram was undertaken. Nonparametric receiver operating characteristic analyses were used to evaluate the relationship between questionnaire scores and OSA as determined by a formal sleep lab study.
There were 266 patients subjected to a standard overnight polysomnogram and screening questionnaires. Area under the curve (AUC) values for analyses including the entire sample were significantly (p < .05) greater than chance (i.e., AUC = .50) for all questionnaire scores except the ESS for both severe OSA (AUC range = .584–.631) and moderate/severe OSA (AUC range = .589–.660), although the magnitude of the AUC values was quite modest. Sensitivity and specificity values from the current study are substantially lower than those previously reported in the literature.
Neither the STOP BANG nor Berlin questionnaires appear to be effective tools for detecting moderate- or high-risk patients for OSA undergoing bariatric surgery.
KeywordsSTOP BANG questionnaire Berlin questionnaire Epworth Sleepiness Scale Obstructive sleep apnea Bariatric surgery
The authors acknowledge Dr. Michel Gagner for his significant guidance, contribution, and expertise in the preparation of this manuscript.
The authors also wish to acknowledge the contribution of Jhanvi Patel, R.N., Bariatric Surgical Program Clinic Director, Humber River Hospital, Toronto, Canada, for her assistance with the data collection.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
This study has been approved by the Research Ethics Board at Humber River Hospital.
For this type of study, formal consent is not required.
- 1.Shahi B, Praglowski B, Deitel M. Sleep-related disorders in the obese. Obes Surg. 1992;2:159–68.Google Scholar
- 3.Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31(8):1079–85.Google Scholar
- 9.Macey PM, Kumar R, Woo MA, et al. Brain structural changes in obstructive sleep apnea. Sleep. 2008;31(7):967–77.Google Scholar
- 12.Anvari M. The Ontario bariatric network group. Ontario bariatric network data, produced and distributed by the Centre for Surgical Invention and Innovation, supported by the Ministry of Health and Long Term Care. Ontario; 2018.Google Scholar
- 14.Quintas-neves M, Preto J, Drummond M. Assessment of bariatric surgery efficacy on obstructive sleep apnea (OSA). Rev Port Pneumol (2006). 2016;22(6):331–6.Google Scholar
- 17.Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54. https://doi.org/10.1056/NEJMoa0901836.
- 20.Gentil B, de Larminat JM, Boucherez C, et al. Difficult intubation and obstructive sleep apnoea syndrome. Br J Anaesth. 1994;72(3):368.Google Scholar
- 21.Nagappa M, Liao P, Wong J, et al. Validation of the STOP-Bang Questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS One. 2015;10(12):e0143697. https://doi.org/10.1371/journal.pone.0143697.eCollection2015.
- 27.Chung F, Ward B, Ho J, et al. Preoperative identification of sleep apnea risk in elective surgical patients, using the Berlin questionnaire. J Clin Anesth. 2007;19(2):130–4.Google Scholar
- 28.Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108(5):822–30. https://doi.org/10.1097/ALN.0b013e31816d91b5.CrossRefPubMedGoogle Scholar
- 31.Deitel M, Field SK, Mehta A, et al. Obstructive sleep apnea in the obese. In: Deitel M, Gagner M, Dixon JB, Himpens J, editors. Handbook of obesity surgery. Toronto: FD Communications; 2010. p. 251–4.Google Scholar
- 33.Chiu H-Y, Chen P-Y, Chuang L-P, et al. Diagnostic accuracy of the berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev. 2017;36:57–70.Google Scholar