Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography

Abstract

Objective: To identify the main predictive factors for obtaining a diagnosis of obstructive sleep apnea (OSA) in patients awaiting bariatric surgery. Methods: Retrospective study of consecutive patients undergoing pre-operative evaluation for bariatric surgery and referred for in-laboratory polysomnography. Eight variables were evaluated: sex, age, neck circumference (NC), BMI, Epworth Sleepiness Scale (ESS) score, snoring, observed apnea, and hypertension. We employed ROC curve analysis to determine the best cut-off value for each variable and multiple linear regression to identify independent predictors of OSA severity. Results: We evaluated 1,089 patients, of whom 781 (71.7%) were female. The overall prevalence of OSA-defined as an apnea/hypopnea index (AHI) ≥ 5.0 events/h-was 74.8%. The best cut-off values for NC, BMI, age, and ESS score were 42 cm, 42 kg/m2, 37 years, and 10 points, respectively. All eight variables were found to be independent predictors of a diagnosis of OSA in general, and all but one were found to be independent predictors of a diagnosis of moderate/severe OSA (AHI ≥ 15.0 events/h), the exception being hypertension. We devised a 6-item model, designated the NO-OSAS model (NC, Obesity, Observed apnea, Snoring, Age, and Sex), with a cut-off value of ≥ 3 for identifying high-risk patients. For a diagnosis of moderate/severe OSA, the model showed 70.8% accuracy, 82.8% sensitivity, and 57.9% specificity. Conclusions: In our sample of patients awaiting bariatric surgery, there was a high prevalence of OSA. At a cut-off value of ≥ 3, the proposed 6-item model showed good accuracy for a diagnosis of moderate/severe OSA.

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

“… 145 Evidence from the population with obesity may merit consideration in this context, given the close association to OSA, 146 reflected in the substantial OSA prevalence of ≤90% in male bariatric patients. 147 , 148 Notably, there is significant overlap between obesity and OSA with regard to challenges in general anesthesia because of altered cardiorespiratory physiology, including decreased functional residual capacity, upper airway obstruction, and the propensity to hypoxemia in perioperative settings. 149 , 150 …”

Fractional Exhaled Nitric Oxide Measurements and Screening of Obstructive Sleep Apnea in a Sleep-Laboratory Setting: A Cross-Sectional Study

“…The estimated prevalence of moderate-to-severe sleep-disordered breathing (SDB) ranges from 10 to 17% among men and from 3 to 9% among women [1], likely reflecting the increase in obesity rates and aging of the population [2,3]. In certain risk groups, such as patients undergoing pre-operative evaluation for bariatric surgery [4] or resistant hypertension [5], the prevalence can reach more than 70%. In patients with OSA, the recurrent snoring and associated local mechanical trauma to the airway along with the recurrent upper airway collapse and intermittent hypoxia-re-oxygenation episodes lead to release of inflammatory mediators, leading to both local upper airway and systemic inflammation [6].…”

Determination of puncture point for spinal needle with ultrasound in a morbidly obese patient

“…Research has shown that to predict sleep apnea syndrome, threshold values for BMI, neck circumference, and age are >42 kg/m 2 , 42 cm, and 37 years, respectively. [3] The patient in this case scored above the 3 threshold values in the STOP-BANG scoring system, but had no diagnosis of sleep apnea syndrome. Nonetheless, the risk was assessed as high.…”