Predicting sleep disordered breathing in outpatients with suspected OSA

Douglas C Cowan, Gwen Allardice, Duncan Macfarlane, Darren Ramsay, Heather Ambler, Stephen Banham, Eric Livingston, Christopher Carlin, Douglas C Cowan, Gwen Allardice, Duncan Macfarlane, Darren Ramsay, Heather Ambler, Stephen Banham, Eric Livingston, Christopher Carlin

Abstract

Objective: To validate the utilities of Berlin, STOP and STOP-BANG Questionnaires, other patient characteristics, comorbidities, Epworth Sleepiness Scale (ESS), fractional exhaled nitric oxide (FENO) and blood markers for the prediction of sleep disordered breathing (SDB) on limited polygraphy.

Setting: North Glasgow Sleep Service (a tertiary referral centre).

Participants: 129 consecutive patients, aged ≥16 years, referred to the sleep clinic for assessment of possible obstructive sleep apnoea.

Interventions: We selected cut-points of apnoea hypopnoea index (AHI) of ≥5 and ≥15/h from their home polygraphy and determined associations of these with individual symptoms, questionnaire scores and other results. Receiver operating characteristic analysis and univariate and multivariate logistic regression were used to explore these.

Primary and secondary outcomes measures: Primary: The utility of STOP, STOP-BANG and Berlin Questionnaires for prediction of SDB. Secondary: The utility of other measures for prediction of SDB.

Results: AHI was ≥5 in 97 patients and ≥15 in 56 patients. STOP and STOP-BANG scores were associated with both AHI cut-points but results with ESS and Berlin Questionnaire scores were negative. STOP-BANG had a negative predictive value 1.00 (0.77-1.00) for an AHI ≥15 with a score ≥3 predicting AHI ≥5 with sensitivity 0.93 (95% CI 0.84 to 0.98) and accuracy 79%, while a score ≥6 predicted AHI ≥15 with specificity 0.78 (0.65 to 0.88) and accuracy 72%. Neck circumference ≥17 inch and presence of witnessed apnoeas were independent predictors of SDB.

Conclusions: STOP and STOP-BANG Questionnaires have utility for the prediction of SDB in the sleep clinic population. Modification of the STOP-BANG Questionnaire merits further study in this and other patient groups.

Keywords: SLEEP MEDICINE.

Figures

Figure 1
Figure 1
Receiver operating characteristic (ROC) curves of logistic models for prediction of sleep disordered breathing (SDB) as defined by: model A: apnoea hypopnoea index (AHI) ≥5 events/h; predict SDB unless neck <17 inch and witnessed apnoeas absent; model B: AHI ≥15 events/h; predict SDB only if neck ≥17 inch and witnessed apnoeas present.

References

    1. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–5
    1. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet 2014;383:736–47
    1. McNicholas WT. Diagnosis of obstructive sleep apnea in adults. Proc Am Thorac Soc 2008;5:154–60
    1. Lacasse Y, Godbout C, Series F. Health-related quality of life in obstructive sleep apnoea. Eur Respir J 2002;19:499–503
    1. Engleman HM, Douglas NJ. Sleep. 4: sleepiness, cognitive function, and quality of life in obstructive sleep apnoea/hypopnoea syndrome. Thorax 2004;59:618–22
    1. Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med 1999;340:847–51
    1. Robinson GV, Stradling JR, Davies RJ. Sleep 6: obstructive sleep apnoea/hypopnoea syndrome and hypertension. Thorax 2004;59:1089–94
    1. Lattimore JD, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol 2003;41:1429–37
    1. Svatikova A, Wolk R, Gami AS, et al. Interactions between obstructive sleep apnea and the metabolic syndrome. Curr Diab Rep 2005;5:53–8
    1. Meslier N, Gagnadoux F, Giraud P, et al. Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 2003;22:156–60
    1. Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20:705–6
    1. Heffner JE, Rozenfeld Y, Kai M, et al. Prevalence of diagnosed sleep apnea among patients with type 2 diabetes in primary care. Chest 2012;141:1414–21
    1. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:11–25
    1. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002;288:1723–7
    1. Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999;131:485–91
    1. Sert Kuniyoshi FH, Zellmer MR, Calvin AD, et al. Diagnostic accuracy of the Berlin Questionnaire in detecting sleep-disordered breathing in patients with a recent myocardial infarction. Chest 2011;140:1192–7
    1. Best MW, Fitzpatrick M, Milev R, et al. Utility of the Berlin questionnaire for predicting obstructive sleep apnea in individuals with treatment-resistant depression. Sleep Breath 2013;17:1221–7
    1. Kang K, Park KS, Kim JE, et al. Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study. Sleep Breath 2013;17:803–10
    1. Ahmadi N, Chung SA, Gibbs A, et al. The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath 2008;12:39–45
    1. Bouloukaki I, Komninos ID, Mermigkis C, et al. Translation and validation of Berlin questionnaire in primary health care in Greece. BMC Pulm Med 2013;13:6.
    1. Saleh AB, Ahmad MA, Awadalla NJ. Development of Arabic version of Berlin questionnaire to identify obstructive sleep apnea at risk patients. Ann Thorac Med 2011;6:212–16
    1. Sforza E, Chouchou F, Pichot V, et al. Is the Berlin questionnaire a useful tool to diagnose obstructive sleep apnea in the elderly? Sleep Med 2011;12:142–6
    1. Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;108:812–21
    1. Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008;108:822–30
    1. Silva GE, Vana KD, Goodwin JL, et al. Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth Sleepiness Scales. J Clin Sleep Med 2011;7:467–72
    1. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540–5
    1. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667–89
    1. Epstein LJ, Kristo D, Strollo PJ, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263–76
    1. Chua AP, Aboussouan LS, Minai OA, et al. Long-term continuous positive airway pressure therapy normalizes high exhaled nitric oxide levels in obstructive sleep apnea. J Clin Sleep Med 2013;9:529–35
    1. Fortuna AM, Miralda R, Calaf N, et al. Airway and alveolar nitric oxide measurements in obstructive sleep apnea syndrome. Respir Med 2011;105:630–6
    1. Depalo A, Carpagnano GE, Spanevello A, et al. Exhaled NO and iNOS expression in sputum cells of healthy, obese and OSA subjects. J Intern Med 2008;263:70–8
    1. Agusti AG, Barbe F, Togores B. Exhaled nitric oxide in patients with sleep apnea. Sleep 1999;22:231–5
    1. Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg 2013;23:2050–7
    1. Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth 2012;108:768–75
    1. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 2008;5:173–8
    1. Wolkove N, Baltzan M, Kamel H, et al. Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J 2008;15:365–9
    1. Iber C, Redline S, Kaplan Gilpin AM, et al. Polysomnography performed in the unattended home versus the attended laboratory setting—Sleep Heart Health Study methodology. Sleep 2004;27:536–40
    1. Flemons WW, Whitelaw WA, Brant R, et al. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med 1994;150:1279–85
    1. Gross JB, Bachenberg KL, Benumof JL, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2006;104:1081–93

Source: PubMed

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