# STOP-Bang–Defined Obstructive Sleep Apnea Risk and Postoperative Nausea and Vomiting in Laparoscopic Surgery Patients: A Prospective Cohort Study

## TL;DR

This study finds that obstructive sleep apnea risk, as measured by the STOP-Bang questionnaire, is linked to postoperative nausea and vomiting in laparoscopic surgery patients.

## Contribution

The study demonstrates a novel clinical link between STOP-Bang-defined obstructive sleep apnea risk and postoperative nausea and vomiting in laparoscopic surgery patients.

## Key findings

- STOP-Bang scores were significantly associated with higher Apfel scores for postoperative nausea and vomiting.
- Female patients scored higher on STOP-Bang, Apfel, and VAS compared to males.
- Younger age was associated with higher PONV scores, while older age was linked to higher OSA risk.

## Abstract

Background: Obstructive sleep apnea (OSA) is frequently underdiagnosed and may influence perioperative outcomes. Postoperative nausea and vomiting (PONV) are common adverse effects following laparoscopic surgery. The purpose of this study was to determine the relationship between PONV and the risk or predisposition of OSA based upon STOP-Bang criteria in laparoscopic surgery patients.

Methods: This is a prospective cohort study conducted in government and private hospitals in Lahore from January to July 2025. The sample consisted of 200 patients who underwent elective laparoscopic surgery under general anesthesia, recruited via convenience sampling. The OSA risk was categorised using the STOP-Bang questionnaire, whereas PONV was measured by the Apfel simplified risk score and the visual analogue scale (VAS). Statistical analyses were performed using SPSS v.26, including descriptive statistics, Spearman correlations, Mann-Whitney U tests, Kruskal-Wallis tests, chi-square tests, and multiple linear regression analyses, while controlling for age, gender, medication use, surgical history, and anesthesia history.

Results: Among the 200 participants, 152 (76%) were female, and 48 (24%) were male. The most common age ranges were 56-60 years (73 participants, 36%) and 46-55 years (54 participants, 27%). The relationships among the Apfel, VAS, and STOP-Bang scores showed moderately positive correlations (r = 0.23, p < 0.01; r = 0.19, p < 0.01). Regression analysis showed that STOP-Bang scores (beta = 0.152, p = 0.003), nausea severity (beta = 0.176, p = 0.003), female gender (beta = 0.125, p = 0.008), and medication use (beta = 0.142, p = 0.003) were associated with higher Apfel scores. Younger age was associated with higher PONV scores (χ² = 21.77, p = 0.001). Female patients scored significantly higher on the STOP-Bang, Apfel, and VAS than males (p < 0.05).

Conclusion: STOP-Bang-defined OSA risk has a significant association with PONV in laparoscopic surgery patients. Female gender and younger age increased susceptibility to PONV, whereas OSA risk was augmented in older people. These results illustrate the clinical utility of integrating STOP-Bang screening into preoperative evaluation to optimise perioperative care and individualise preventive measures against PONV. These findings support integrating STOP-Bang screening into preoperative risk assessment to improve postoperative outcomes.