The value of nurse-led anthropometric and oropharyngeal measurements combined with STOP-Bang questionnaire in screening for obstructive sleep apnea in patients with acute coronary syndrome: a prospective cohort study

Zexuan Li, Hua Miao, Siyu Zhang, Jingyao Fan, Yan Yan, Wei Gong, Wen Zheng, Xiao Wang, Bin Que, Hui Ai, Lixin Zhang, Shaoping Nie, Zexuan Li, Hua Miao, Siyu Zhang, Jingyao Fan, Yan Yan, Wei Gong, Wen Zheng, Xiao Wang, Bin Que, Hui Ai, Lixin Zhang, Shaoping Nie

Abstract

Background: Obstructive sleep apnea (OSA) is a modifiable risk factor for acute coronary syndrome (ACS), with high prevalence but low diagnostic rates. Therefore, it is particularly important to develop strategies for better screening for OSA in newly admitted ACS patients.

Methods: From March 2017 to October 2019, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. All anthropometric and oropharyngeal parameters are measured by specialist nurses.

Results: Finally, 761 ACS patients were recruited in the present study. Prevalence of moderate/severe OSA was 53.2% based on diagnostic criteria of AHI ≥ 15. Correlation analysis illustrated that AHI was positively correlated with anthropometric characteristics. In the multivariate model, only micrognathia (OR 2.02, 95% CI 1.02-4.00, P = 0.044), waist circumference (OR 1.08, 95% CI 1.04-1.11, P < 0.001), and STOP-BANG Questionnaire (SBQ) score (OR 1.45, 95% CI 1.27-1.66, P < 0.001) were independently associated with the prevalence of OSA. Receiver operating characteristic curve (ROC) analysis showed that the area under curve (AUC) of multivariable joint diagnosis (waist circumference, micrognathia combined with SBQ) was significantly better than the AUC of Epworth Sleepiness Scale (ESS) and SBQ (p < 0.0001 and p = 0.0002, respectively), and the results showed that AUC was 0.728. Under the optimal truncation value, the sensitivity was 73%, and the specificity was 61%, which was higher than the single index. Finally, we also constructed a nomogram model based on multiple logistic regression, to easily determine the probability of OSA in ACS patients.

Conclusions: The new screening tool has greater power than single questionnaire or measurements in screening of OSA among ACS patients.

Trial registration: Clinicaltrials.gov identifier NCT03362385, registered December 5, 2017.

Keywords: Acute coronary syndrome; Anthropometric measurements; Obstructive sleep apnea; Oropharyngeal; STOP-Bang questionnaire.

Conflict of interest statement

Dr. Shaoping Nie: research grants to the institution from Boston Scientific, Abbott, Jiangsu Hengrui Pharmaceuticals, China Resources Sanjiu Medical & Pharmaceuticals, East China Pharmaceuticals. Other authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study flowchart. CPAP: continuous positive airway pressure; OSA: obstructive sleep apnea
Fig. 2
Fig. 2
Receiver operating characteristic curve for the individual components and composite screening test. ESS: Epworth sleepiness scale; ROC: Receiver operating characteristic; SBQ: Stop-bang questionnaire; WC: waist circumference
Fig. 3
Fig. 3
Nomogram to estimate the risk of moderate/severe OSA in Patients with ACS

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