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AKRON, Ohio — Nine in every 10 patients awaiting weight-loss surgery suffer from sleep apnea, a much higher percentage than are typically diagnosed, a University Hospitals of Cleveland study has found.

In a group of 249 patients followed between December 2003 and August 2005, 19 percent had been diagnosed with obstructive sleep apnea. However, after all the patients were tested in sleep labs before surgery, it was found that 91 percent of those patients actually had the condition.

"It's a medical disease that is really under-recognized," said Dr. Peter Hallowell, a University Hospitals bariatric surgeon who led the study with Dr. Thomas A. Stellato.

"Hypertension is known as the silent killer and sleep apnea is the same exact thing," he said. "People are going to work everyday, getting sleepy during the day, getting sleepy behind the wheel and getting in accidents. There's a certain public health concern with this. That's one of the big take-home messages of this."

Sleep apnea is a condition that causes people to stop breathing for 10 to 20 seconds during sleep, sometimes as often as 20 to 30 times an hour. It can lead to hypertension, daytime sleepiness, mood swings, headaches and depression.

Obesity has long been seen as a contributing factor for sleep apnea, though Hallowell said most studies have estimated that 30 percent to 50 percent of obese people have sleep apnea. Finding that the percentage appears to be closer to 90 percent is shocking.

"This is something that a lot of people just don't know," Hallowell said. "We need to get the word out that people who are morbidly obese are at risk of this. Even if they're not considering bariatric surgery, they should be evaluated" for sleep apnea.

Deitra Byrd, a 62-year-old retired nurse from Akron, said she had sleep apnea "for four or five years and I had no idea. I think a lot of people have it and just don't know."

Within two months of having weight-loss surgery, Byrd had lost 50 pounds and her sleep apnea was gone.

"I could sleep again," she said. "I was rested, where before I'd wake up and feel like I'd been hit by a Mack truck. I knew I went to bed at a decent hour, but I didn't feel rested. The weight had a lot to do with that."

Byrd weighed more than 300 pounds before her surgery in September 2004 and is now down to 170 pounds.

Obesity is not the only cause of sleep apnea. Other causes include a narrowed airway, high blood pressure and smoking.

The study was published in the American Journal of Surgery.