Original article
Validity of a simple sleep monitor for diagnosing OSA in bariatric surgery patients

https://doi.org/10.1016/j.soard.2018.02.019Get rights and content

Abstract

Background

One third of bariatric surgery patients have an apnea–hypopnea index (AHI)>15/hr, representing moderate and severe forms of obstructive sleep apnea (OSA). Treating these forms of OSA is recommended to reduce the risk of perioperative complications. The AHI derived from poly(somno)graphy [P(S)G] is the gold standard for OSA diagnosis. However, performing P(S)G in all patients scheduled for bariatric surgery is time consuming and expensive. An accurate and simple screening tool able to rule out moderate to severe OSA would reduce the number of patients needing mandatory P(S)Gs.

Objectives

To assess the validity of a simple sleep monitor (Checkme Health Monitor) as a screening tool for OSA in bariatric surgery patients.

Setting

Obesity Center Amsterdam, OLVG-West, Amsterdam, the Netherlands

Methods

Patients scheduled for bariatric surgery were prospectively enrolled in this study. All patients underwent preoperative P(S)G and simultaneously used the Checkme to assess the oxygen desaturation index. The diagnostic performance of the Checkme for AHI ≥15/hr was assessed using receiver operating characteristic curve analysis.

Results

A total of 50 patients were analyzed. Sensitivity and negative predictive value were 100% and 100%, respectively, specificity and positive predictive value were 69% and 64%, respectively, for the optimal cutoff value of Checkme-3% oxygen desaturation index ≥9/hr for P(S)G-AHI ≥15. The area under the curve value expressed by the receiver operating characteristic curve was .95.

Conclusion

The Checkme is valid for exclusion of moderate and severe OSA in bariatric surgery patients. The Checkme enables bariatric clinics not to perform P(S)G in all patients scheduled for bariatric surgery.

Section snippets

Study design and population

We performed a prospective, single-center pilot study involving patients scheduled for primary or revisional bariatric surgery in the OLVG West, Amsterdam, the Netherlands. Bariatric surgery patients were included consecutively. All patients met the International Federation for the Surgery of Obesity and Metabolic Disorders criteria for bariatric surgery [11]. In the OLVG West, Amsterdam, ambulant polygraphy (PG) and, in some cases, ambulant PSG is routine preoperative care in bariatric surgery

Study population

From October 2016 to March 2017, a total of 52 of 68 patients completed the study (42 [81%] female, age 42 ± 5 yr, body mass index 42.8 ± 5.0 kg/m2). Sixteen patients returned the Checkme without any registered data. Two patients were excluded from further analysis due to a Checkme recording time<3.5 hours (possibly due to movement of the oxygen sensor). The remaining 50 patients had a mean recording time of 7.2 hours and were included for analysis. A total of 11 patients (22%) underwent

Discussion

In this study we found good agreement between the Checkme and the gold standard P(S)G as expressed by the ICC (ICC .85, 95% CI .75–.91). We demonstrated a small systematic difference between the P(S)G-AHI and the Checkme-ODI. For mean values of circa ≤15, the distribution of the Bland-Altman plot was sufficiently narrow, which means that the Checkme and the P(S)G may be essentially equivalent in these values. The limits of agreement got wider in higher values, which means that the bias between

Conclusion

The Checkme cannot replace the P(S)G but can be used as a valid screening tool to rule out moderate and severe OSA in bariatric surgery patients who present for preoperative evaluation. In our population, 42% of the patients could have been withheld an extensive sleep study, using the Checkme data.

Disclosures

N. de Vries is a member of the Medical Advisory Board of Revent Medial and NightBalance and has stock options and shares in ReVent Medical and NightBalance, respectively. He is also an investigator of Inspire, consultant of Philips, Olympus, and the AE Mann Foundation and has inventor patent on PCT/US2010/062576, including devices, systems, and methods for monitoring sleep position.

Acknowledgments

We would like to acknowledge BodiMetrics for supplying the Checkme pro for this study.

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