In Reply

We appreciated the reply letter by Chung et al., and we completely agree with their conclusions. As we underline in our former letter,¹  it is surprising and unjustified, on the basis of the evidence, that the authors of the Practice Guidelines did not recommend the use of the STOP-Bang questionnaire.^2,3  In addition, stating that the STOP-Bang scores have been shown not to correlate with the severity of obstructive sleep apnea (OSA) is really surprising because robust data support that higher STOP-Bang scores significantly increase the probability of OSA.^4,5  Since 2012, the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care (SIAARTI) implemented the recommendation for perioperative management of OSA patients undergoing surgery, including the STOP-Bang questionnaire as cornerstone to rule in/rule out the disease in patients who never underwent an overnight monitoring.⁶  In this guideline, the allocation of the patient to a risk category drives the criteria for a safe OSA patient discharge from the postanesthesia care unit to unmonitored settings.⁷  Differently, the Task Force of the American Society states that, to decide whether the patient should be discharged to an unmonitored bed, it is necessary to observe “patients in an unstimulated environment, preferably while asleep,” an approach which cannot be considered a “reasoned clinical decision”²  indeed.

In conclusion, the currently available data in the literature, as stressed by Chung et al., support not only the correlation between a higher STOP-Bang score and the severity of OSA but also that at the present time it is imperative to adopt all the strategies to reduce perioperative risk.