Identifying the optimal STOP-Bang screening score for obstructive sleep apnea among bariatric surgery patients. Surg Obes Relat Dis 2024 Nov;20(11):1154-1162
Date
07/11/2024Pubmed ID
38987026DOI
10.1016/j.soard.2024.06.004Scopus ID
2-s2.0-85197769522 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: Undiagnosed obstructive sleep apnea (OSA) increases the risk of perioperative complications in bariatric patients. Validated screening methods exist, but are not specific to patients with severe obesity.
OBJECTIVES: Determine the ideal OSA screening tool for bariatric surgery patients balancing accuracy and cost-effectiveness.
SETTING: University Hospital.
METHODS: Bariatric surgery patients from January 2018 to September 2023 were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. For patients with a STOP-Bang score of ≥4 referred for polysomnogram additional variables were collected from the electronic medical record. The Berlin Score was retrospectively calculated.
RESULTS: Out of 484 patients who underwent bariatric surgery, 167 (34.5%) had a STOP-Bang score ≥4. The receiver operating characteristic (ROC) curve for STOP-Bang scores ≥4 had an area under the curve (AUC) of 78.5% for predicting OSA and 83.7% for OSA requiring treatment (Apnea Hypopnea Index [AHI] ≥ 15), compared to Berlin Scores' AUC of 80.7% and 88.6%, respectively. A STOP-Bang score of 4 had a sensitivity of 55.6% and specificity of 36.8%, while a score of 5 had 29.3% and 66.2%, respectively. A Berlin Score of 3 had a sensitivity of 47.5% and specificity of 69.1%, with 30 patients (44.1%) starting OSA treatment. Thirty-five patients (21%) experienced a delay in insurance submission, averaging 41.5 days, related to OSA workup.
CONCLUSION: The Berlin questionnaire outperforms STOP-Bang in predicting OSA requiring treatment. Raising the polysomnography referral score from STOP-Bang ≥4 to ≥5 or utilizing a Berlin Score of ≥3, may alleviate resource burden, reduce costs, and expedite medical optimization for bariatric surgery.
Author List
Turbati MS, Kindel TL, Higgins RMAuthors
Rana Higgins MD Associate Professor in the Surgery department at Medical College of WisconsinTammy Lyn Kindel MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultBariatric Surgery
Female
Humans
Male
Mass Screening
Middle Aged
Obesity, Morbid
Polysomnography
ROC Curve
Retrospective Studies
Sleep Apnea, Obstructive
