Key result
Berlin Questionnaire yields ~89% sensitivity while Epworth maximizes specificity for predicting moderate-to-severe OSA in morbid obesity.
Why the study?
This study aimed to evaluate the diagnostic accuracy of the Epworth Sleepiness Scale, STOP-BANG, and Berlin Questionnaire for detecting moderate to severe obstructive sleep apnea in patients with morbid obesity.
Do the Epworth Sleepiness Scale, STOP-BANG, and Berlin Questionnaire accurately predict moderate to severe obstructive sleep apnea in patients with morbid obesity?
Cross-Sectional (n=205)
No
Do the Epworth Sleepiness Scale, STOP-BANG, and Berlin Questionnaire accurately predict moderate to severe obstructive sleep apnea in patients with morbid obesity?
Effect estimate: AUC 0.656 (95% CI 0.551-0.750)
p-value: p=0.015
In patients with morbid obesity, the Berlin Questionnaire offers the highest sensitivity while the Epworth Sleepiness Scale provides the highest specificity for screening moderate to severe obstructive sleep apnea.
Berlin Questionnaire may aid sensitive OSA screening in morbid obesity; cross-sectional data leaves open prospective validation before practice change.
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/m² or ≥32 kg/m² 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/m² . 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 SpO₂). 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.
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Chinnalai et al. (2025) conducted a cross-sectional in Obstructive sleep apnea (n=205). Epworth Sleepiness Scale (ESS), STOP-BANG, and Berlin Questionnaire (BQ) vs. Polysomnography was evaluated on Diagnostic accuracy (AUC) of STOP-BANG for detecting moderate to severe OSA (AUC 0.656, 95% CI 0.551-0.750, p=0.015). The Berlin Questionnaire had the highest sensitivity (88.9%) and the Epworth Sleepiness Scale had the highest specificity (52.0%) for predicting moderate to severe OSA in morbidly obese patients.
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