Diagnostic Accuracy of Three Screening Questionnaires for Predicting Moderate to Severe Obstructive Sleep Apnea in Patients With Morbid Obesity

Objective: This study aimed to evaluate the accuracy of the Epworth Sleepiness Scale (ESS), STOP-BANG, and Berlin Questionnaire (BQ) in detecting moderate to severe obstructive sleep apnea (OSA) in patients with morbid obesity. Methods: A cross-sectional study was conducted in adults with morbid obesity who were suspected of having OSA. Morbid obesity was defined as a body mass index (BMI) of ≥37 kg/m<sup>2</sup> or ≥32 kg/m<sup>2</sup> with diabetes or two obesity-related comorbidities. ESS, STOP-BANG, and BQ were assessed prior to polysomnography. Results: A total of 205 subjects (40.5% male) were included, with a mean age of 43.2±14.3 years and a BMI of 40.9±5.3 kg/m<sup>2</sup> . Neck circumference (NC) averaged 42.48±4.14 cm. The apnea-hypopnea index (AHI) was 59.4±39.2 events/h. The severity of OSA was: mild (9.8%), moderate (14.6%), and severe (73.2%). Optimal cutoff values for ESS, STOP-BANG, and BQ in detecting moderate to severe OSA were 6.5, 4.5, and 1.5, respectively. Sensitivity levels were 61.7%, 67.2%, and 88.9%, with specificity levels of 52.0%, 36.0%, and 36.0%, respectively. The area under the receiver operating characteristic curve values for ESS, STOP-BANG, and BQ were 0.624, 0.656, and 0.649, respectively. The predictive equation for AHI (events/h) was calculated as: -12.041 + (12.636×BQ scores) + (1.227×BMI) + (1.622×NC) - (0.991×lowest SpO<sub>2</sub>). Conclusion: BQ demonstrated the highest sensitivity, while ESS exhibits the highest specificity for predicting moderate to severe OSA in patients with morbid obesity. These questionnaires could serve as predictive tools for screening OSA in this population.