Top

Published in:

01-09-2018 | Original Contributions

Prevalence and Prediction of Obstructive Sleep Apnea Prior to Bariatric Surgery—Gender-Specific Performance of Four Sleep Questionnaires

Authors: Christian M. Horvath, Juri Jossen, Dino Kröll, Philipp C. Nett, Florent Baty, Anne-Kathrin Brill, Sebastian R. Ott

Published in: Obesity Surgery | Issue 9/2018

Abstract

Purpose

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.

Results

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.

Conclusion

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.

Ravesloot MJL, van Maanen JP, Hilgevoord AAJ, et al. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. Eur Arch Otorhinolaryngol. 2012;269:1865–71. https://doi.org/10.1007/s00405-012-1948-0.CrossRefPubMedPubMedCentral

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery a systematic review and meta-analysis. JAMA. 2004;292:1724–37. https://doi.org/10.1001/jama.292.14.1724. CrossRefPubMed

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.

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.CrossRef

Fassbender P, Herbstreit F, Eikermann M, et al. Obstructive sleep apnea—a perioperative risk factor. Dtsch Arztebl Int. 2016;113:463–9. https://doi.org/10.3238/arztebl.2016.0463. CrossRefPubMedPubMedCentral

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.CrossRef

Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014;24:42–55. https://doi.org/10.1007/s11695-013-1079-8.CrossRefPubMed

Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15:376–81.CrossRef

Valko PO, Bassetti CL, Bloch KE, et al. Validation of the fatigue severity scale in a Swiss cohort. Sleep. 2008;31:1601–7.CrossRef

10.

Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21. https://doi.org/10.1097/ALN.0b013e31816d83e4.CrossRefPubMed

11.

Marti-Soler H, Hirotsu C, Marques-Vidal P, et al. The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. Lancet Respir Med. 2016;0:310–8. https://doi.org/10.1016/S2213-2600(16)30075-3. CrossRef

12.

Sareli AE, Cantor CR, Williams NN, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary center experience. Obes Surg. 2011;21:316–27. https://doi.org/10.1007/s11695-009-9928-1.CrossRefPubMed

13.

Khan A, King WC, Patterson EJ, et al. Assessment of obstructive sleep apnea in adults undergoing bariatric surgery in the longitudinal assessment of bariatric surgery-2 (LABS-2) study. J Clin Sleep Med. 2013;9:21–9. https://doi.org/10.5664/jcsm.2332.CrossRefPubMedPubMedCentral

14.

Sharkey KM, Orff HJ, Tosi C, et al. Subjective sleepiness and daytime functioning in bariatric patients with obstructive sleep apnea. Sleep Breath. 2013;17:267–74. https://doi.org/10.1007/s11325-012-0685-3.CrossRefPubMed

15.

Sharkey KM, Machan JT, Tosi C, et al. Predicting obstructive sleep apnea among women candidates for bariatric surgery. J Women's Health (Larchmt). 2010;19:1833–41. https://doi.org/10.1089/jwh.2009.1859.CrossRef

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. CrossRefPubMedPubMedCentral

17.

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.CrossRef

18.

R: The R Project for Statistical Computing. https://www.r-project.org/. Accessed 24 Apr 2016.

19.

Robin X, Turck N, Hainard A, et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics. 2011;12:77. https://doi.org/10.1186/1471-2105-12-77.CrossRefPubMedPubMedCentral

20.

Dixon JB, Schachter LM, O’Brien PE. Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Chest. 2003;123:1134–41.CrossRef

21.

Peppard PE, Young T, Palta M, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284:3015–21.CrossRef

22.

Quintana-Gallego E, Carmona-Bernal C, Capote F, et al. Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respir Med. 2004;98:984–9.CrossRef

23.

Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg. 2013;23:2050–7. https://doi.org/10.1007/s11695-013-1006-z.CrossRefPubMed

24.

Mohsenin V. Effects of gender on upper airway collapsibility and severity of obstructive sleep apnea. Sleep Med. 2003;4:523–9.CrossRef

25.

Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:136–43. https://doi.org/10.1513/pats.200709-155MG.CrossRefPubMedPubMedCentral

26.

Wimms A, Woehrle H, Ketheeswaran S, et al. Obstructive sleep apnea in women: specific issues and interventions. Biomed Res Int. 2016;2016:1764837–9. https://doi.org/10.1155/2016/1764837.CrossRefPubMedPubMedCentral

Title: Prevalence and Prediction of Obstructive Sleep Apnea Prior to Bariatric Surgery—Gender-Specific Performance of Four Sleep Questionnaires
Authors: Christian M. Horvath
Juri Jossen
Dino Kröll
Philipp C. Nett
Florent Baty
Anne-Kathrin Brill
Sebastian R. Ott
Publication date: 01-09-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 9/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-018-3222-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prevalence and Prediction of Obstructive Sleep Apnea Prior to Bariatric Surgery—Gender-Specific Performance of Four Sleep Questionnaires

Abstract

Purpose

Material and Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Material and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2018

Factors Influence the Acceptance of Surgical Treatment in Chinese Bariatric Surgery Candidates

Practices Concerning Revisional Bariatric Surgery: a Survey of 460 Surgeons

Correction to: Comparison of Early Morbidity and Mortality Between Sleeve Gastrectomy and Gastric Bypass in High-Risk Patients for Liver Disease: Analysis of American College of Surgeons National Surgical Quality Improvement Program

Two-Year Nutrition Data in Terms of Vitamin D, Vitamin B12, and Albumin After Bariatric Surgery and Long-term Fracture Data Compared with Conservatively Treated Obese Patients: a Retrospective Cohort Study

Janeway Gastrostomy for Trans-gastric ERCP: an Emergency Alternative Method to Access the Excluded Structures

Bariatric Surgery in Immunocompromised Patients: Outcomes from One Year Follow-up