Borsini EE, Blanco M, Ernst G, Montenegro P, Salvado A, Nigro C. Simulated intention-to-treat analysis based on clinical parameters of patients at high risk for sleep apnea derivated to respiratory polygraphy.
ACTA ACUST UNITED AC 2018;
11:160-165. [PMID:
30455848 PMCID:
PMC6201519 DOI:
10.5935/1984-0063.20180030]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose
Obstructive Sleep Apnea-Hypopnea Syndrome (OSAS) is a public health problem.
We designed a pilot study to validate empiric indication of CPAP therapy in
a population with moderate-to-high pre-test probabilities who underwent
self-administered home-based respiratory polygraphy (RP).
Methods
A cross-sectional simulation study was performed. CPAP therapy could be
indicated by two independent blind observers. Observer 1´s decision was
based on the results of STOP-BANG (SBQ) and Epworth Sleepiness Scale (ESS)
and Observer 2 used all objective data provided by RP + SBQ + ESS.
Results
We evaluated 1763 patients; 1060 men and 703 women (39.2%) with a mean age
of 53.6±13.8 and a body mass index (BMI) of 32.8±7.5 kg/m2. We
found evidence of mild (34.1%), moderate (26.6%), and severe (18.3%) There
were Apnea-Hypopnea Index (AHI) relationship between > 5 or < 5 SBQ
and RP AHI (p<0.05). BMI > 25 kg/m2 +
snoring (S) + observed apnea (O) + 1 of the following: ESS > 11,
hypertension (HT) or > 5 SBQ components showed sensitivity of 40% (CI95%:
37.3-43) and specificity of 95.1% (CI93.4-96.4). The performance of 5 SBQ
components with regard to gender and empirical CPAP therapy was; (women vs.
men): AUC-ROC 0.625 (CI95%: 0.599-0.651) vs. 0.70 (CI95%:
0.68-0.72), p<0.01, respectively.
Conclusions
STOP-BANG and ESS made it possible to indicate CPAP reliably (low rate of
false-positive results) in 20-40% of patients who needed such therapy
according to clinical history and RP results. These clinical criteria
performed better in male.
Collapse