Validation Performance of Screening Tools for Predicting Obstructive Sleep Apnea Among Chinese Patients Undergoing Metabolic Bariatric Surgery: Insights from a Multicenter Database.

BACKGROUND

Obstructive sleep apnea (OSA) is highly prevalent among metabolic bariatric surgery patients and may increase perioperative complications; however, the performance of commonly used OSA screening tools in this population remains unclear. This study aimed to evaluate the predictive performance of B-APNEIC, STOP-BANG, GOAL, No-Apnea, NoSAS and NO-OSAS questionnaires in Chinese bariatric cohort.

METHODS

This cross-sectional study utilizes data from Chinese Obesity and Metabolic Surgery (COMES) database between January 2021 and January 2025. Performance of six screening tools was assessed using the area under the receiver operating characteristic curve (AUC) and Youden index. OSA severity was classified based on Apnea-hypopnea index (AHI): any OSA(AHI ≥ 5/h), moderate-to-severe OSA (AHI ≥ 15/h), and severe OSA(AHI ≥ 30/h).

RESULTS

1740 patients were included (39.2% male) with a median age of 31.0 years and a median body mass index (BMI) of 38.9 kg/m². Overall, 77.1% had OSA, including 49.9% with moderate-to-severe OSA and 33.0% with severe OSA. Questionnaire scores were positively correlated with AHI (all p < 0.001). STOP-BANG [AUC 0.75 (95% confidence interval (CI): 0.70-0.75)] and NO-OSAS [AUC 0.73 (95% CI: 0.71-0.75)] showed comparable performance (P = 0.727) for predicting both any OSA and moderate-to-severe OSA, outperforming GOAL, No-Apnea, NoSAS, and B-APNEIC. For severe OSA, NO-OSAS demonstrated superior performance [AUC 0.75 (95% CI: 0.73-0.77)] compared with STOP-BANG and the other questionnaires (all p < 0.05).

CONCLUSIONS

STOP-BANG and NO-OSAS demonstrated similar discriminatory ability for detecting any OSA and moderate-to-severe OSA in Chinese bariatric cohort. However, NO-OSAS may be more effective for identifying severe OSA.