Abstract：
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.
OBJECTIVE: Determine the ideal OSA screening tool for bariatric surgery patients balancing accuracy and cost-effectiveness.
METHODS: 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.
CONCLUSIONS: 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.
OBJECTIVE: Determine the ideal OSA screening tool for bariatric surgery patients balancing accuracy and cost-effectiveness.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：未确诊的阻塞性睡眠呼吸暂停（OSA）会增加减肥患者围手术期并发症的风险。存在经过验证的筛选方法，但不是针对严重肥胖患者。
目的：为减肥手术患者确定理想的OSA筛查工具，以平衡准确性和成本效益。
方法：大学医院。
方法：从代谢和减重手术认证和质量改进计划（MBSAQIP）数据库中确定了2018年1月至2023年9月的减重手术患者。对于多导睡眠图的STOP-Bang评分≥4的患者，从电子病历中收集了其他变量。柏林评分是回顾性计算的。
结果：在484名接受减肥手术的患者中，167人（34.5%）的STOP-Bang评分≥4。STOP-Bang评分≥4的受试者工作特征（ROC）曲线的曲线下面积（AUC）为78.5％，对于需要治疗的OSA为83.7％（呼吸暂停低通气指数[AHI]≥15），与柏林的80.7%和88.6%的AUC相比，分别。STOP-Bang评分为4分，敏感性为55.6％，特异性为36.8％，5分分别为29.3%和66.2%，分别。柏林得分为3分的敏感性为47.5％，特异性为69.1％，30例患者（44.1%）开始OSA治疗。35名患者(21%)经历了保险提交延迟，平均41.5天，与OSA检查有关。
结论：柏林问卷在预测OSA需要治疗方面优于STOP-Bang。将多导睡眠图转诊评分从STOP-Bang≥4提高到≥5或利用柏林评分≥3可以减轻资源负担。降低成本,加快减肥手术的医疗优化。
目的：为减肥手术患者确定理想的OSA筛查工具，以平衡准确性和成本效益。
方法：大学医院。
方法：从代谢和减重手术认证和质量改进计划（MBSAQIP）数据库中确定了2018年1月至2023年9月的减重手术患者。对于多导睡眠图的STOP-Bang评分≥4的患者，从电子病历中收集了其他变量。柏林评分是回顾性计算的。
结果：在484名接受减肥手术的患者中，167人（34.5%）的STOP-Bang评分≥4。STOP-Bang评分≥4的受试者工作特征（ROC）曲线的曲线下面积（AUC）为78.5％，对于需要治疗的OSA为83.7％（呼吸暂停低通气指数[AHI]≥15），与柏林的80.7%和88.6%的AUC相比，分别。STOP-Bang评分为4分，敏感性为55.6％，特异性为36.8％，5分分别为29.3%和66.2%，分别。柏林得分为3分的敏感性为47.5％，特异性为69.1％，30例患者（44.1%）开始OSA治疗。35名患者(21%)经历了保险提交延迟，平均41.5天，与OSA检查有关。
结论：柏林问卷在预测OSA需要治疗方面优于STOP-Bang。将多导睡眠图转诊评分从STOP-Bang≥4提高到≥5或利用柏林评分≥3可以减轻资源负担。降低成本,加快减肥手术的医疗优化。
