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DOISNORE50: A perioperative sleep questionnaire predictive of obstructive sleep apnea and postoperative medical emergency team activation. a learning health system approach to sleep questionnaire development and screening.

STUDY OBJECTIVES
Patients with obstructive sleep apnea (OSA) have a disproportionate increase in post-operative complications and medical emergency team activation (META). We previously introduced DOISNORE50 (D-diseases, O-observed apnea, I-insomnia, S-snoring, N-neck circumference > 18 inches, O-obesity with BMI > 32, R-are you male, E-excessive daytime sleepiness, 50-age ≥ 50) from sleep questionnaire ISNORED (IS) using features associated with increased odds of META in perioperative patients. Performance of DOISNORE50 (DOISNORE) had yet to be tested.


METHODS
The performance of DOISNORE was tested along with IS and STOP-Bang (SB) questionnaires among 300 out of 392 participants without known OSA referred to the sleep lab. In study 2, the performance of DOISNORE was tested among 64,949 lives screened in perioperative assessment clinic from 2016 to 2020.


RESULTS
Receiver operating characteristic (ROC) curve demonstrated that best performance was achieved with DOISNORE ≥ 6, with area under curve (AUC) of 0.801. DOISNORE's predictability of OSA risk remained stable from 2016-2020 with AUC of 0.78 and a Cronbach alpha of 0.65. Patients at High Risk for OSA (DOISNORE ≥ 6) were associated with an increase of META (OR 1.30, 95% CI 1.12 - 1.45). Higher relative risk was noted among patients with congestive heart failure and hypercapnia.


CONCLUSIONS
DOISNORE is predictive of OSA and postoperative META. Perioperative strategies against META should consider DOISNORE questionnaire and focused screening among patients with heart failure and hypercapnia.