Comment on: Sleep apnoea in patients undergoing colorectal cancer surgery: prospective cohort study

Correspondence to: Xiqiang Zhuang (email: 408159021@qq.com)

Department of General Surgery

The Second Affiliated Hospital of Fujian Medical University

Quanzhou

Fujian

China

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BJS Open, https://doi.org/10.1093/bjsopen/zrag025, published 15 April 2026

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We read with great interest the study by Claesson et al.1 regarding the prevalence of sleep apnoea in patients undergoing colorectal cancer surgery. The authors are to be commended for a rigorous prospective design using attended polysomnography (PSG) with EEG-based sleep staging. The finding that 48% (95% c.i. 41 to 54%) of patients harbour moderate-to-severe sleep apnoea is a crucial wake-up call for perioperative physicians.

However, we wish to offer a note of caution regarding the clinical implementation of the authors' conclusion that "overnight sleep apnoea assessment is required in this population". While this recommendation follows logically from the high disease prevalence, it must be weighed against the diagnostic performance of the available screening tool reported in the study.

The authors report that the STOP-Bang questionnaire (score ≥3) demonstrated a sensitivity of 85% but a specificity of only 42% for detecting moderate-to-severe sleep apnoea. This low specificity presents a significant barrier to routine screening. In a population with a disease prevalence as high as 48%, the use of a test with 42% specificity inevitably generates a substantial false-positive burden. Given that the authors themselves note that attended PSG is "impractical for routine preoperative screening" due to its "complexity and cost", a universal confirmatory testing strategy appears untenable in most healthcare systems.

We therefore suggest that the authors' important finding should prompt a refinement, rather than a wholesale adoption, of screening protocols. We fully support the authors' suggestion that level 3 home sleep apnoea testing (HSAT) is a more feasible alternative. A tiered approach - initial screening with STOP-Bang, followed by HSAT for those scoring ≥3, and reserving in-laboratory PSG for diagnostically challenging or high-risk cases - would preserve sensitivity while mitigating the resource implications of a high false-positive rate.

In summary, Claesson et al. have definitively established that colorectal cancer surgery patients are a high-risk group for sleep apnoea. We argue that the path forward lies not in universal PSG, but in the pragmatic integration of simplified home monitoring into enhanced recovery pathways.