High Rate of Undiagnosed Obstructive Sleep Apnea in Patients Undergoing Total Joint Arthroplasty

This study described the incidence and severity of obstructive sleep apnea (OSA) and determined the sensitivity and specificity of the STOP-BANG Questionnaire in patients undergoing total joint arthroplasty (TJA) at a military academic medical center. All subjects completed the questionnaire and an unattended sleep study preoperatively. Incidence and severity of OSA (apnea-hypopnea index [AHI] ≥ 5) was calculated. Sensitivity and specificity for STOP-BANG cut scores greater than or equal to 3 and 5 for AHI of 5, 15, and 30 or more were determined. The rate of OSA was 51.2% (42/82), moderate to severe OSA was 29.3% (n = 29), and severe OSA was 7.3% (n = 6). Sensitivity and specificity for a STOP-BANG score of 3 or greater were 85.7% and 43.6% for OSA, 91.7% and 36.8% for moderate OSA, and 100% and 30.7% for severe OSA. A STOPBANG score of 5 or greater increased specificity for mild, moderate, and severe OSA to 84.6%, and 78.9%, and 72%. Patients undergoing TJA have a high rate of undiagnosed OSA. It is recommended to screen these patients using the STOP-BANG, implement OSA risk reduction strategies, and refer patients postoperatively for a sleep study if their STOP-BANG score is at least 3.