A simplified model of screening questionnaire and home monitoring for obstructive sleep apnoea in primary care (original) (raw)
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Comparison of two home sleep testing devices with different strategies for diagnosis of OSA
Sleep and Breathing, 2017
Purpose-Home sleep testing devices are being widely used in diagnosis/screening for obstructive sleep apnea (OSA). We examined differences in OSA metrics obtained from two devices with divergent home monitoring strategies; the Apnea Risk Evaluation System (ARES™, multiple signals plus forehead reflectance oximetry) and the Nonin WristOx 2 ™ (single channel finger transmission pulse oximeter), compared to differences from night-night variability of OSA. Methods-152 male / 26 female subjects (BMI=30.3±5.6 kg/m2, age=52.5±8.9 yrs) were recruited without regard to OSA symptoms, and simultaneously wore both ARES™ and Nonin WristOx 2 ™ for 2 nights (n=351 nights). Automated analysis of the WristOx 2 yielded ODI Ox2 (Oxygen Desaturation Index, #≥4% O2 dips/hr) and automated analysis with manual editing of ARES™ yielded AHI4 ARES (apneas+hypopneas with ≥4% O2 dips/hr) and RDI ARES (apneas+ hypopneas with ≥4% O2 dips/hr or arousal surrogates). Baseline awake oxygen saturation, percent time <90% O2 saturation (% time <90% O2Sat) and O2 signal loss were compared between the two methods.
Sleep Medicine, 2018
Study Objectives: Obstructive Sleep Apnea (OSA) contributes to all-cause mortality. An American Academy of Sleep Medicine task force is focusing on improving detection and categorization of OSA symptoms and severity to promote screening, assessment, and diagnosis. The purpose of this study was to psychometrically compare measures used in OSA screening (Berlin, Epworth Sleepiness Scale (ESS), STOP Bang) and a portable sleep monitor (PSM) to apnea-hypopnea index (AHI) levels from polysomnogram (PSG). Methods: An observational, cross-sectional design was used. Patients referred to a sleep specialist were enrolled at initial sleep evaluation. Participants completed measures used in OSA screening, then sent home for one night using PSM. PSGs were ordered by the physician and AHI results were obtained from the medical record. Results: Participants (N=170) were enrolled in the study. Almost all participants completed the OSA measures, approximately half-completed PSM measurement, and the majority completed laboratory PSG. The STOP Bang had the highest levels of sensitivity; the ESS had the lowest. The ESS had the highest specificity and reliability levels; the STOP Bang had the lowest. The PSM measure had the highest positive predictive value (PPV) and the strongest psychometric properties of the screening measures. Conclusions: The STOP Bang was the preferred self-report OSA screening measure because of high levels of sensitivity. The ESS was the least desirable measure. PSM measurement consistently predicted the presence of OSA but at the expense of low sensitivity at AHI levels ≥ 30. This expands the knowledge of validity testing of screening measures used for OSA.
Assessing the likelihood of obstructive sleep apnea: a comparison of nine screening questionnaires
Sleep and Breathing, 2017
Purpose Several questionnaires are available for the screening of obstructive sleep apnea (OSA). Herein, we compare the performance characteristics of nine available questionnaires for assessing the likelihood of OSA. Methods Consecutive subjects who underwent polysomnography at the sleep laboratory of the unit were included. Subjects with obstructive events and apnea hypopnea index (AHI) ≥5 were considered to have OSA. The likelihood ratios (LRs) and other performance characteristics were calculated for the following nine questionnaires:Berlin,modifiedBerlin,STOP,STOP-BangandOSA50 questionnaires, sleep apnea clinical score (SACS), Epworth sleepiness scale (ESS), American Society of Anesthesiologists (ASA) checklist, and the elbow sign questionnaire. Results Two-hundred and ten subjects (mean age, 46.5 years; mean body mass index [BMI], 31.9 kg/m 2 ; 27.1% women) were included. OSA was diagnosed in 78.1% of patients; 49.5% had severe OSA (AHI ≥30). The SACS questionnaire had the highest positive LR (LR+, 5.6) and positive predictive value (95.2%). The modified Berlin questionnaire had the best negative LR (LR−, 0.2) and the highest negative predictive value (57.1%). The STOP-Bang questionnaire also had an LR − of 0.2 if BMI threshold of 25 kg/m 2 (like that in the modified Berlin questionnaire) was used. Among individual items of various sleep questionnaires, the highest LR+ was obtained for neck circumference >43 cm (LR+, 4.9), while the best LR − was obtained for snoring and BMI >25 kg/m 2 (LR−, 0.2). Conclusions The SACS and the STOP-Bang questionnaires (BMI threshold of 25 kg/m 2) were found to provide the best positive and negative LRs, respectively, for the prediction of OSA. We believe that information from these questionnaires may help in prioritizing patients for sleep studies in highvolume centers.
Applied Sciences
Diagnosis and effective treatment of obstructive sleep apnea syndrome (OSA) in adults is an important health priority. Home respiratory polygraphy is a cost-effective alternative to polysomnography in OSA. The aim of this study was to investigate the variability of two consecutive home respiratory polygraphic examinations by comparing the severity characteristics and pattern (supine dominant, continuous, etc.) variability. We examined 100 patients with clinically suspected OSA on two consecutive nights by home respiratory polygraphy. The correlation of time in bed (TIB), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and T90 of the two examinations were compared by the Pearson test. The severity ranks and nocturnal apnea patterns of the two periods were compared using Spearman and Wilcoxon tests. Pearson’s correlations represented a strong correlation of the AHI, ODI, and T90, but only moderate for TIB. The severity-specific correlation was the highest for AHI in the s...
Detection and screening of obstructive sleep apnea in primary care
International Journal of Community Medicine and Public Health, 2022
The most prevalent sleep-related breathing condition, obstructive sleep apnea (OSA), is linked to greater morbidity and poor cardiovascular outcomes. Even though sleep disorders are frequently present, primary care physicians hardly see or treat them. Better OSA symptom and intensity identification and classification to support OSA evaluation and diagnosis were the first outcomes of a task group of the American Academy of Sleep Medicine that produced quality metrics for the treatment of adult patients with the condition in 2015. The OSA screening tools (Berlin questionnaire, Epworth sleepiness scale, STOP Bang) have proven to be effective instruments for screening of sleep disorders. The present primary care practice approach for OSA screening and evaluation is disorganized and inadequate. Patients with OSA symptomatology are seen by primary care physicians, but they are not regularly screened, assessed, or referred to a sleep specialist. For the OSA screening assessments in general practice, more psychometric investigations are required. The findings from these investigations can be applied in real-world settings to improve OSA identification.
Sleep Science, 2022
Objectives: Assess reliability of oxygen desaturation index (ODI) as an alternative parameter to apnea hypopnea index (AHI) in screening patients with severe obstructive sleep apnea (OSA). Material and Methods: Retrospectively two-year data on demography, anthropometric features, polysomnography (PSG) parameters [AHI, ODI, minimum oxygen saturation (SpO2), mean SpO2], and Epworth sleepiness score (ESS) were collected and analyzed. Results: Study showed significant correlation of ESS with AHI, ODI, apnea-hypopnea percentage of sleep period time (AH%SPT), mean SpO2 and minimum SpO2 with highest correlation being with AHI. A Cohen's weighted Kappa analysis showed good concordance of 87.32% between AHI and ODI in classifying severity of OSA, with a significant R 2 correlation of 0.84 on linear regression. An ODI>20 has a sensitivity of 96.6% and specificity of 69.6% in diagnosing severe OSA. Conclusion: Good concordance between AHI and ODI makes nocturnal oximetry a less expensive tool to confidently screen patients with severe OSA.
Feasibility of Single Channel Oximetry for Mass Screening of Obstructive Sleep Apnea
EClinicalMedicine
Background: The growing awareness for the high prevalence of obstructive sleep apnea (OSA) coupled with the dramatic proportion of undiagnosed individuals motivates the elaboration of a simple but accurate screening test. This study assesses, for the first time, the performance of oximetry combined with demographic information as a screening tool for identifying OSA in a representative (i.e. non-referred) population sample. Methods: A polysomnography (PSG) clinical database of 887 individuals from a representative population sample of São Paulo's city (Brazil) was used. Using features derived from the oxygen saturation signal during sleep periods and demographic information, a logistic regression model (termed OxyDOSA) was trained to distinguish between non-OSA and OSA individuals (mild, moderate, and severe). The OxyDOSA model performance was assessed against the PSG-based diagnosis of OSA (AASM 2017) and compared to the NoSAS and STOP-BANG questionnaires. Findings: The OxyDOSA model had mean AUROC = 0.94 ± 0.02, Se = 0.87 ± 0.04 and Sp = 0.85 ± 0.03. In particular, it did not miss any of the 75 severe OSA individuals. In comparison, the NoSAS questionnaire had AUROC = 0.83 ± 0.03, and missed 23/75 severe OSA individuals. The STOP-BANG had AUROC = 0.77 ± 0.04 and missed 14/75 severe OSA individuals. Interpretation: We provide strong evidence on a representative population sample that oximetry biomarkers combined with few demographic information, the OxyDOSA model, is an effective screening tool for OSA. Our results suggest that sleep questionnaires should be used with caution for OSA screening as they fail to identify many moderate and even some severe cases. The OxyDOSA model will need to be further validated on data recorded using overnight portable oximetry.
Validation of Oximetry for Diagnosing Obstructive Sleep Apnea in a Clinical Setting
Clocks & Sleep, 2020
A large epidemiological study using oximetry to analyze obstructive sleep apnea (OSA) and metabolic comorbidities was performed in Japan; however, reliability and validity of oximetry in the Japanese population remains poorly understood. In this study, oximetry data from the epidemiological study were compared with data from clinically performed polysomnography (PSG) and out-of-center sleep testing (OCST) in epidemiological study participants who later attended our outpatient units. The oxygen desaturation index (ODI) from oximetry showed a moderate positive relationship (correlation coefficient r = 0.561, p < 0.001) with apnea/hypopnea data from PSG/OCST. The area under the receiver operating characteristic curve showed moderate accuracy of this method in the detection of moderate-to-severe or severe OSA. However, the optimal ODI thresholds to detect moderate-to-severe OSA and severe OSA were the same (ODI > 20.1). Oximetry may be a useful tool for screening moderate-to-sever...
Family Medicine and Community Health, 2017
Objective: To estimate prevalence of OSA among at risk adult patients in primary care setting. To test the correlation and agreement between overnight pulse oximetry and polysomnography (PSG). To test the OSA screening performance of overnight pulse oximetry. Design and Setting: Prospective case series involving adult Chinese patients with risk factors for OSA at a primary care clinic of Hong Kong. Methods: The prevalence and severity of OSA were established based on overnight pulse oximetry derived oxygen desaturation index (ODI). Screening performance of overnight pulse oximetry was compared directly with gold standard diagnostic test PSG. Results: Three hundred and five male and 229 female patients were recruited. Snoring (48.3%) was the top presenting symptom. Three hundred and twenty five patients (60.9%) were screened positive to have OSA. One hundred and nine patients had performed PSG, the ODI_4 and apnoea-hypopnea index (AHI) had Pearson correlation coeffi cient 0.71 (P<0.001). Bland and Altman plot showed good agreement. Using designation criteria of ODI_4≥5 events/hr, the sensitivity and specifi city for OSA diagnosis are 94.4% and 78.9% respectively. Conclusion: The prevalence of OSA is 60.9% among adult primary care population who are at risk for OSA. Overnight pulse oximetry shows good performance as a screening tool for the screening of OSA.