title: Abbreviated right-sided heart echocardiogram and the STOP-Bang questionnaire-a useful relationship for preoperative patient evaluation?
abstract: OBJECTIVE
  The aims of this study were to (1) explore the incidence of right-sided heart dysfunction (RHD) and STOP-Bang questionnaire responses consistent with obstructive sleep apnea (OSA) and (2) assess the relationship between patients with STOP-Bang questionnaire responses consistent with OSA and echocardiographic findings suggestive of RHD.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Tertiary academic center preoperative clinic.
  
  
  METHODS
  Two hundred patients presenting for elective surgery to the University of Utah preoperative clinic.
  
  
  METHODS
  Abbreviated transthoracic right-sided echocardiogram and STOP-Bang questionnaire.
  
  
  METHODS
  Tricuspid annular plane systolic excursion, tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), and the tricuspid inflow E wave to tricuspid annular tissue Doppler e' wave ratio (E/e') for the presence of RHD, as well as responses to STOP-Bang questionnaire.
  
  
  RESULTS
  A total of 140 echocardiograms were analyzed after exclusion of participants with incomplete STOP-Bang questionnaires and inadequate images. Thirty-five patients (25%) reported 5 or more positive responses to the STOP-Bang questionnaire. Forty-six patients (35%) had abnormal right-sided heart measurements. Of the 35 patients with STOP-Bang scores 5 or greater, 11 (31%) had evidence of RHD. No correlation was observed between STOP-Bang scores and the echocardiography metrics of RHD.
  
  
  CONCLUSIONS
  This preliminary study suggests that there are numerous sources of RHD, among one of which is sleep apnea, and/or the STOP-Bang questionnaire is not a sensitive tool for predicting RHD. We conclude that although the STOP-Bang questionnaire is easy to implement in a preoperative clinical setting, it is not useful in identifying patients at risk for RHD.
authors.affiliation: Department of Anesthesiology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756, USA. Electronic address: Rebecca.E.Evans@hitchcock.org.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Evans
authors.affiliation: Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA. Electronic address: Joshua.Zimmerman@hsc.utah.edu.
authors.forename: Joshua
authors.initials: J
authors.lastname: Zimmerman
authors.affiliation: Bend Anesthesiology Group, 2500 NE Neff Rd, Bend, OR 97701, USA. Electronic address: sonia.shishido@gmail.com.
authors.forename: Sonia
authors.initials: S
authors.lastname: Shishido
authors.affiliation: Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA. Electronic address: Elise.Heath@hsc.utah.edu.
authors.forename: Elise
authors.initials: E
authors.lastname: Heath
authors.affiliation: Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA. Electronic address: Amber.Bledsoe@hsc.utah.edu.
authors.forename: Amber
authors.initials: A
authors.lastname: Bledsoe
authors.affiliation: Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA. Electronic address: Ken.B.Johnson@hsc.utah.edu.
authors.forename: Ken
authors.initials: K
authors.lastname: Johnson
mesh_terms: D015150:Echocardiography, Doppler / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000453:epidemiology
keywords: Obstructive sleep apnea; Preoperative evaluation; Right-sided heart dysfunction; STOP-Bang questionnaire; Transthoracic echocardiography