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Obstructive sleep apnoea (OSA) is widely prevalent with obesity; its effect on OSA is multifactorial 1 SD increase in BMI increases risk of OSA by 4 fold (Young et al, NEJM 1993)  The prevalence of OSA correlates well with the BMI; however the severity of OSA does not correlate well to the BMI in severely obese; the risk of severe OSA in these patient is as high as 95% (Serafini et al, Obes surgery 2001) There is a significant overlay of OSA with Obesity hypoventilation syndrome (OHS) in this cohort and it is common to assume that managing one could complement the other Epworth sleepiness scale (ESS) is a common screening tool for day time sleepiness, a complication of OSA  Good at predicting OSA but not predicting its severity (Serafini, Obes Surg 2001)  Good positive correlation with AHI index (Yeh, Obes Surg 2010) STOP BANG  in general practice a cut off of 3 is used; in bariatric practices generally a cut off of 5 is recommended  ≥ 5 correlated well with severe to very severe OSA (Chung, BJA 2011) Due to the evolving and dynamic nature of the bariatric service and modifications to its framework at our LHE, the guidelines at our hospital included a wide range of different clinical practice with time. This includes a combination of  ABG : with triggers of saturation <92% or pO2 <8 or pCO2 >6  STOP BANG Score  Epworth Sleepiness score (ESS) >10  Baseline spirometry

Pre-operative assessment for Sleep apnoea in patients referred for bariatric surgery: the usefulness of various clinical screening tools