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Subjective sleepiness and daytime functioning in bariatric patients with obstructive sleep apnea

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Abstract

Purpose

The purpose of this study was to evaluate associations between obstructive sleep apnea (OSA) severity and self-reported sleepiness and daytime functioning in patients considering bariatric surgery for treatment of obesity.

Methods

Using a retrospective cohort design, we identified 342 patients who had sleep evaluations prior to bariatric surgery. Our final sample included 269 patients (78.6 % of the original cohort, 239 females; mean age = 42.0 ± 9.5 years; body mass index = 50.2 ± 7.7 kg/m2) who had overnight polysomnography and completed the Epworth Sleepiness Scale (ESS) and the Functional Outcomes of Sleep Questionnaire (FOSQ). Patients' OSA was classified as none/mild (apnea–hypopnea index (AHI) < 15, n = 112), moderate (15 ≤ AHI < 30, n = 77), or severe (AHI ≥ 30, n = 80). We calculated the proportion of unique variance (PUV) for the five FOSQ subscales. ANOVA was used to determine if ESS and FOSQ were associated with OSA severity. Unpaired t tests compared ESS and FOSQ scores in our sample with published data.

Results

The average AHI was 29.5 ± 31.5 events per hour (range = 0–175.8). The mean ESS score was 6.3 ± 4.8, and the mean global FOSQ score was 100.3 ± 18.2. PUVs for FOSQ subscales showed moderate-to-high unique contributions to FOSQ variance. ESS and global FOSQ score did not differ by AHI group. Only the FOSQ vigilance subscale differed by OSA severity with the severe group reporting more impairment than the moderate and none/mild groups. Our sample reported less sleepiness and daytime impairment than previously reported means in patients and controls.

Conclusions

Subjective sleepiness and functional impairment were not associated significantly with OSA severity in our sample of patients considering surgery for obesity. Further research is needed to understand individual differences in sleepiness in patients with OSA. If bariatric patients underreport symptoms, self-report measures are not an adequate substitute for objective assessment and clinical judgment when evaluating bariatric patients for OSA. Patients with severe obesity need evaluation for OSA even in the absence of subjective complaints.

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Acknowledgments

The authors thank the polysomnographic technologists and clerical staff at the Sleep Disorders Center for their excellent work with our patients.

Conflicts

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA

    Katherine M. Sharkey, Christine Tosi & Richard P. Millman

  2. Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA

    Katherine M. Sharkey

  3. Department of Psychiatry, University of California, San Diego, San Diego, CA, USA

    Henry J. Orff

  4. Department of Surgery, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA

    David Harrington & G. Dean Roye

  5. Division of Pulmonary, Critical Care, and Sleep Medicine; Sleep for Science Research Laboratory, Brown University/Rhode Island Hospital, 300 Duncan Drive, Providence, RI, 02906, USA

    Katherine M. Sharkey

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  1. Katherine M. Sharkey
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Correspondence to Katherine M. Sharkey.

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Sharkey, K.M., Orff, H.J., Tosi, C. et al. Subjective sleepiness and daytime functioning in bariatric patients with obstructive sleep apnea. Sleep Breath 17, 267–274 (2013). https://doi.org/10.1007/s11325-012-0685-3

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  • DOI: https://doi.org/10.1007/s11325-012-0685-3

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