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.

Competing Interests

The authors declare no competing interests.

References

1.
Corso
RM
,
Gregoretti
C
,
Braghiroli
A
,
Fanfulla
F
,
Insalaco
G
:
Practice guidelines for the perioperative management of patients with obstructive sleep apnea: Navigating through uncertainty.
Anesthesiology
2014
;
121
:
664
5
2.
Practice guidelines for the perioperative management of patients with obstructive sleep apnea: An updated report by the American Society of Anesthesiologists Task Force on the Perioperative Management of Patients with Obstructive Sleep Apnea.
Anesthesiology
2014
;
120
:
268
86
3.
Gross
JB
,
Apfelbaum
JL
,
Connis
RT
,
Nickinovich
DG
:
In reply.
Anesthesiology
2014
;
121
:
667
8
4.
Chung
F
,
Subramanyam
R
,
Liao
P
,
Sasaki
E
,
Shapiro
C
,
Sun
Y
:
High STOP-Bang score indicates a high probability of obstructive sleep apnoea.
Br J Anaesth
2012
;
108
:
768
75
5.
Farney
RJ
,
Walker
BS
,
Farney
RM
,
Snow
GL
,
Walker
JM
:
The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: Relation to polysomnographic measurements of the apnea/hypopnea index.
J Clin Sleep Med
2011
;
7
:
459
65B
6.
Petrini
F
,
Vicini
C
,
Gregoretti
C
,
Corso
RM
:
Raccomandazioni SIAARTI AIMS per la gestione perioperatoria del paziente affetto da Sindrome delle Apnee Ostruttive del Sonno. Prot. n. 454 SIAARTI 2009/2012, 15 maggio.
2012
http://www.siaarti.it. Accessed March 27, 2015
7.
Gali
B
,
Whalen
FX
,
Schroeder
DR
,
Gay
PC
,
Plevak
DJ
:
Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment.
Anesthesiology
2009
;
110
:
869
77