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

Abstract

Purpose 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). Methods A cross-sectional analysis of morbidly obese patients (body mass index [BMI] ≥ 35.0 kg/m 2 ) 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 ). Results 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). Conclusions 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.

Screening for Obstructive Sleep Apnea in a Diverse Bariatric Surgery Population

“…Importantly, when used for preoperative screening (i.e., identification of the highest‐risk individuals who warrant further testing with a sleep study), both STOP‐BANG and NO‐OSAS appeared to have a higher specificity (i.e., lower false‐positive rate) compared with No‐Apnea and the ESS, although confidence intervals (CI) slightly overlapped. This is consistent with a study by Duarte et al, which also found a lower specificity with No‐Apnea compared with STOP‐BANG when using cutoffs with comparable sensitivity (15). Moreover, our results validate the use of previously established cutoffs for the screening of moderate to severe OSA in a diverse bariatric surgery population: as in prior studies, STOP‐BANG ≥ 4, NO‐OSAS ≥ 3, and No‐Apnea ≥ 3 achieved a sensitivity > 80% while maintaining a similar specificity as in previous studies (50%‐60% for STOP‐BANG and NO‐OSAS vs. 30%‐40% for No‐Apnea) (3,15,17).…”

Prediction of obstructive sleep apnea: comparative performance of three screening instruments on the apnea-hypopnea index and the oxygen desaturation index

“…Several instruments have been developed over the years including the STOP-Bang questionnaire [6,7] and the NoSAS score [8]. The STOP-Bang questionnaire shows a high sensitivity and negative predictive value, and therefore is a suitable instrument to rule out patients at risk for OSA [9][10][11][12]. However, it has a low to moderate specificity and it is possible that this will yield a high false-positive rate.…”

Effects of Whole-Body Vibration Exercises on Parameters Related to the Sleep Quality in Metabolic Syndrome Individuals: A Clinical Trial Study

“…The questionnaire score ranges between 0 and 24. Higher total scores are related to more sleepiness [39].…”