A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study

Patricia Peñacoba, Maria Antònia Llauger, Ana María Fortuna, Xavier Flor, Gabriel Sampol, Anna Maria Pedro-Pijoan, Núria Grau, Carme Santiveri, Joan Juvanteny, José Ignacio Aoiz, Joan Bayó, Patricia Lloberes, Mercè Mayos, PASHOS Working Group, Leandra Domínguez Olivera, Pepi Valverde Trillo, MªÁngeles Santos Santos, Mª Del Mar Farga Martínez, Montserrat Reverté Simó, Núria Argemí Saburit, Casimira Medrano Medrano, Marineus Puig García, Patricia Peñacoba, Maria Antònia Llauger, Ana María Fortuna, Xavier Flor, Gabriel Sampol, Anna Maria Pedro-Pijoan, Núria Grau, Carme Santiveri, Joan Juvanteny, José Ignacio Aoiz, Joan Bayó, Patricia Lloberes, Mercè Mayos, PASHOS Working Group, Leandra Domínguez Olivera, Pepi Valverde Trillo, MªÁngeles Santos Santos, Mª Del Mar Farga Martínez, Montserrat Reverté Simó, Núria Argemí Saburit, Casimira Medrano Medrano, Marineus Puig García

Abstract

Background: The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting.

Methods: Anthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the β coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed.

Results: 194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763-0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% ≥ 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863-0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7-92.1) and specificity of 67.8% (95% CI 55.1-78.3).

Conclusions: The use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment. Clinical Trial Registration Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://ichgcp.net/clinical-trials-registry/NCT02591979 ; Identifier: NCT02591979. Date of registration: October 30, 2015.

Keywords: Continuous positive airway pressure (CPAP); Home sleep apnea test; Obstructive sleep apnea; Primary healthcare; Screening model; Sleep unit.

Conflict of interest statement

The first author and none of the other authors have any affiliations or financial involvement that conflict with the material presented in this study.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of the study population (OSA: obstructive sleep apnea; HSAT: home sleep apnea test; RP: respiratory polygraphy; PSG; polysomnography)
Fig. 2
Fig. 2
Diagnostic accuracy of the PASHOS Test for a cut-off value of ≥ 5 and different study questionnaires (left panel) as well as variables obtained with the home sleep apnea test (right panel) (AUC: area under the ROC curve; CI: confidence interval; AHI: apnea–hypopnea index; ODI3%: oxygen desaturation index of 3%; ODI4%: oxygen desaturation index of 4%)

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