Background

Introduction: Screening for obstructive sleep apnea (OSA) represents a key element of the preoperative assessment of adolescent patients undergoing bariatric surgery. Yet no reliable screening tools exists to risk stratify patients to determine the need for polysomnogram. Objectives: The aim of this study was to develop a risk-stratification model for OSA screening in adolescent patients seeking bariatric surgery.

Methods

Retrospective review of 111 medical records of participants seen in our institution’s bariatric surgery program. Participants were divided into two groups, no/mild versus moderate/severe OSA (defined by obstructive apnea hypopnea index (OAHI) of <15 and >15, respectively). Demographic, anthropometric, metabolic, polysomnographic and co-morbidity related data were compared between groups. Regression models were used to determine clinical characteristics associated with OSA.

Results

Of the 111 participants studied (mean age 16.1 ± 1.3 years; 73.9% female), 60/111 (54.1%) had no/mild OSA and 51/111 (45.9%) had moderate/severe OSA. Those with moderate/severe OSA had significantly higher BMI (53.2 vs. 48.7 kg/m2, p< 0.007), lower 25-hydroxyvitamin D levels (15.4 vs. 18.6 ng/mL, p<0.01), and were more likely to be male (60.8% vs. 15.8%, p<0.004). Receiver operator analysis (ROC) of these clinical variables yielded an area under the curve receiver (AUC) of 0.68.

Conclusions

Male gender, BMI > 53 mg/kg2, and severe vitamin D deficiency were identified as independent predictors of moderate/severe OSA. However, the value of using them combined as a screening tool was only modest. Therefore, until reliable screening measures are developed, baseline polysomnography should be included in the preoperative assessment adolescent bariatric surgery candidates.