Purpose: The main study objective was to assess the predictive value of selected physical symptoms for screening obstructive sleep apnea and major cardiac conditions in adults with obesity, thus providing the evidence for routine symptom screening of obesity complications endorsed by obesity management clinical practice guidelines.
Methods: We performed a retrospective cohort study using patient-reported outcomes data including the physical symptoms severity component of the Memorial Symptom Assessment Scale administered through Audio Computer-Assisted Self-Interviews combined with data from the electronic medical records of an urban safety-net primary care clinic. Non-underweight ambulatory patients completing the standardized survey assessment were included. The prevalence of pre-selected symptoms and the diagnostic characteristics at various severity cut-points were determined for obstructive sleep apnea or major cardiac conditions separately for patients with and without obesity.
Results: Of the 1399 patients included in this analysis, most (77%) were non-hispanic black or hispanic. Step-wise increases in positive likelihood ratios ranging between 1.2 and 4.6 with greater severity cough, dyspnea, fatigue, bloating, dizziness, and nausea were observed for both obstructive sleep apnea and major cardiac complications. Likelihood ratio estimates for both obese and non-obese patients were statistically significant.
Conclusions: Our findings provide a basis to support current guideline recommendations for routine symptom screening to identify medical complications among patients with BMI 30 kg/m2 or greater.
Keywords: Obesity; Patient-reported outcomes; Screening; Underserved populations.