Screening for Obstructive Sleep Apnea in a Diverse Bariatric Surgery Population

Objective Obstructive sleep apnea (OSA) is common among bariatric surgery patients and is associated with perioperative risk. Preoperative screening is recommended, but some screening tools lack validation, and their relative performance is unclear in this population. The study objective was to compare the ability of four existing tools (STOP-BANG, NO-OSAS, No-Apnea, and the Epworth Sleepiness Scale [ESS]) to screen for moderate to severe OSA in a diverse bariatric cohort. Methods Data from patients presenting for first-time bariatric surgery who underwent a sleep study within 1 year of the initial encounter were retrospectively reviewed. Performance of the four tools for detecting moderate to severe OSA was compared based on the area under the receiver operating characteristic curves (AUC). Results Of the included 214 patients (83.2% female, median age 39 years), 45.3% had moderate to severe OSA. Based on AUC, STOP-BANG (0.75 [95% CI: 0.68-0.81], N = 185), NO-OSAS (0.76 [95% CI: 0.69-0.82], N = 185), and No-Apnea (0.69 [95% CI: 0.62-0.76], N = 190) had similar performance (P > 0.16). Compared with STOP-BANG and NO-OSAS, ESS (0.61 [95% CI: 0.54-0.68], N = 198) had a significantly lower AUC (P < 0.01). Hispanic/Latino self-identification, sex, or obesity class did not significantly modify test performance. Conclusions STOP-BANG and NO-OSAS may be preferable to No-Apnea and ESS when screening bariatric surgery patients for moderate to severe OSA. Efforts to screen bariatric patients for OSA are recommended.