Development and Feasibility of Two Novel Scores (DX-OSA and A-OSA) for the Identification of Significant Obstructive Sleep Apnoea in Surgical Patients with Obesity

Abstract

Background: There is a high prevalence of undiagnosed obstructive sleep apnoea (OSA) in patients with obesity undergoing bariatric surgery. We developed two novel scores in order to investigate the extent to which anthropometric and other objective measurements can be used to identify the presence of moderate-severe OSA (Apnoea/Hypopnoea Index (AHI) ≥ 15/h) in surgical patients with obesity.Methods: We prospectively evaluated 1870 adult patients scheduled for elective laparoscopic bariatric surgery. Prior to surgery, body mass index (BMI), sex, neck circumference, STOP-Bang score, SpO2, and neck/trunk fat were recorded. Basic anthropometric measurements were obtained, and the A Body Shape Index (ABSI) was calculated using the Krakauer formula. Patients at high risk for OSA were referred for polysomnography. Auto-titrated positive airway pressure (APAP) therapy was initiated when AHI ≥ 15/h. The Dual-X Ray-Obstructive Sleep Apnoea (DXOSA) score included six items: STOP-Bang score, BMI, neck fat, trunk fat, baseline SpO2, and expiratory reserve volume (ERV). The Anthropometric-OSA (A-OSA) score included STOP-Bang score, BMI, NC, ABSI coupled with WC, baseline SpO2, and ERV. We then compared sensitivity, specificity, positive-predictive values, negativepredictive values, likelihood ratios, and post-test probabilities in these patients.Results: Using a cut-off of 3, the DX-OSA and A-OSA scores exhibited similar sensitivity to STOP-Bang scores, but were associated with improved specificity, lower false positive rates, and increased probability for the diagnosis of moderate-severe OSA.Conclusion: The A-OSA and DX-OSA scores may be useful in the identification of obese surgical patients requiring CPAP treatment for significant OSA, without the need for formal polysomnography.