Comparison of Stop-Bang Scores between Patients Undergoing Endoscopic Endonasal Approach Surgery for Resection of Pituitary Adenoma

Introduction: The STOP-BANG questionnaire is a validated screening tool for obstructive sleep apnea (OSA) and considers a history of snoring, fatigue, observed apneic episodes, hypertension, BMI, age, neck circumference, and gender. Patients undergoing endoscopic endonasal approach (EEA) surgery for pituitary adenoma resection can present with physical changes reflective of hormonal imbalances (e.g., weight gain with Cushing’s disease), which can contribute to increased risk of OSA and thus a higher STOP-BANG score. Therefore, we sought to compare STOP-BANG scores between patients who underwent EEA surgery for pituitary adenoma resection with respect to their specific pituitary pathology.

Materials and Methods: This single-institution, retrospective chart review study consisted of patients undergoing EEA surgery for presumed pituitary adenoma from 2017–2023. STOP-BANG scores were collected from patient’s pre-operative notes. The surgical pathology report was used to categorize patients into corticotroph, somatotroph, lactotroph, gonadotroph, thyrotroph, plurihormonal (non-cotricotroph), null cell adenoma, and normal pituitary gland. Patients with Rathke’s cleft cyst were excluded from analysis. Standard t-test (assuming equal variance, α = 0.05) was used to compare mean STOP-BANG scores between groups consisting of at least 30 members.

Results: A total of 244 patients underwent EEA surgery for resection of a pituitary adenoma during the studied timeframe (mean STOP-BANG score ± SD = 2.9 ± 1.9). 58 patients (24%) had confirmed corticotropic adenomas and 58 (24%) had gonadotrophic adenomas, representing the largest groups ([Table 1]). There was no statistically significant difference in mean STOP-BANG score between patients with corticotropic adenomas (Cushing’s disease) and non-corticotropic adenomas (3.2 vs. 2.9; p = 0.25). However, STOP-BANG scores were significantly different between patients with gonadotropic adenomas versus non-gonadotropic adenomas (3.5 vs. 2.8; p = 0.006), gonadotropic versus null cell adenomas (3.5 vs. 2.2; p < 0.005), corticotropic versus null cell adenomas (3.2 vs. 2.2; p = 0.01), corticotropic vs normal pituitary gland (3.2 vs. 2.1; p < 0.005), and gonadotropic versus normal pituitary gland (3.5 vs. 2.1; p < 0.005).

Conclusion: Mean STOP-BANG scores of patients varied significantly when grouped and compared by pituitary pathology. These findings suggest certain pituitary adenomas (e.g., gonadotrophic) may be more predictive of OSA risk than others (e.g., null cell). Recognizing these variations can help clinicians better identify and manage patients at increased risk for OSA, ultimately improving perioperative care and outcomes for those undergoing EEA surgery for pituitary adenomas.

Table 1

Pathology	Number (%)	STOP-BANG mean ± SD
Corticotroph (ACTH-secreting)	58 (24)	3.2 ± 1.8
Somatotroph (GH-secreting)	15 (6)	3.9 ± 1.6
Lactrotroph (prolactin-secreting)	15 (6)	2.5 ± 2.3
Gonadotroph (LH/FSH-secreting)	58 (24)	3.5 ± 1.6
Thyrotroph (TSH-secreting)	5 (2)	4.4 ± 1.9
Null cell adenoma	38 (16)	2.2 ± 2
Plurihormonal adenoma (non-corticotroph)	3 (1)	3.3 ± 1.2
Normal pituitary tissue	52 (21)	2.1 ± 1.6
Total	244	2.9 ± 1.9

Publication History

Article published online:
07 February 2025