Validation of the GOAL Questionnaire as an Obstructive Sleep Apnea Screening Instrument in Bariatric Surgery Candidates: a Brazilian Single-Center Study

Abstract

Objective To validate the GOAL questionnaire as obstructive sleep apnea (OSA) screening tool in bariatric surgery (BS) patients and compare it with other existing instruments. Methods Before performing full polysomnography (PSG), all participants were screened for OSA with the following instruments: GOAL, STOP, STOP-Bang, No-Apnea, NoSAS, and Epworth Sleepiness Scale (ESS). Discrimination was assessed by area under the curve (AUC), while predictive parameters were calculated by contingency tables. Correlation was evaluated by the Spearman correlation coefficient (r). OSA severity was classified based on the apnea/hypopnea index (AHI): >= 5.0/h (OSA(>= 5)), >= 15.0/h (OSA(>= 15)), and >= 30.0/h (OSA(>= 30)). Results Overall, 814 BS individuals (70.8% of females) were enrolled. We found a high prevalence of OSA(>= 5)(82.6%), OSA(>= 15)(60.0%), and OSA(>= 30)(38.8%). GOAL questionnaire was positively correlated with the AHI (r = 0.570,p < 0.001). Using a score >= 2 to classify patients at high risk of OSA, GOAL questionnaire had sensitivities ranging from 73.7 to 89.2% and specificities ranging from 78.2 to 51.0% for predicting OSA(>= 5), OSA(>= 15), and OSA(>= 30). At all OSA severity levels, GOAL exhibited similar and non-inferior discrimination when compared with STOP-Bang, No-Apnea, and NoSAS (allpvalues > 0.05), and performed significantly better than STOP and ESS (allpvalues < 0.001). Conclusions In a cohort of BS patients, GOAL, No-Apnea, STOP-Bang, and NoSAS, but not ESS and STOP, enable satisfactory discrimination as OSA screening instruments at all disease severity levels.