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Sheta A, Thaher T, Surani SR, Turabieh H, Braik M, Too J, Abu-El-Rub N, Mafarjah M, Chantar H, Subramanian S. Diagnosis of Obstructive Sleep Apnea Using Feature Selection, Classification Methods, and Data Grouping Based Age, Sex, and Race. Diagnostics (Basel) 2023; 13:2417. [PMID: 37510161 PMCID: PMC10377846 DOI: 10.3390/diagnostics13142417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep disorder that affects approximately 3-7% of males and 2-5% of females. In the United States alone, 50-70 million adults suffer from various sleep disorders. OSA is characterized by recurrent episodes of breathing cessation during sleep, thereby leading to adverse effects such as daytime sleepiness, cognitive impairment, and reduced concentration. It also contributes to an increased risk of cardiovascular conditions and adversely impacts patient overall quality of life. As a result, numerous researchers have focused on developing automated detection models to identify OSA and address these limitations effectively and accurately. This study explored the potential benefits of utilizing machine learning methods based on demographic information for diagnosing the OSA syndrome. We gathered a comprehensive dataset from the Torr Sleep Center in Corpus Christi, Texas, USA. The dataset comprises 31 features, including demographic characteristics such as race, age, sex, BMI, Epworth score, M. Friedman tongue position, snoring, and more. We devised a novel process encompassing pre-processing, data grouping, feature selection, and machine learning classification methods to achieve the research objectives. The classification methods employed in this study encompass decision tree (DT), naive Bayes (NB), k-nearest neighbor (kNN), support vector machine (SVM), linear discriminant analysis (LDA), logistic regression (LR), and subspace discriminant (Ensemble) classifiers. Through rigorous experimentation, the results indicated the superior performance of the optimized kNN and SVM classifiers for accurately classifying sleep apnea. Moreover, significant enhancements in model accuracy were observed when utilizing the selected demographic variables and employing data grouping techniques. For instance, the accuracy percentage demonstrated an approximate improvement of 4.5%, 5%, and 10% with the feature selection approach when applied to the grouped data of Caucasians, females, and individuals aged 50 or below, respectively. Furthermore, a comparison with prior studies confirmed that effective data grouping and proper feature selection yielded superior performance in OSA detection when combined with an appropriate classification method. Overall, the findings of this research highlight the importance of leveraging demographic information, employing proper feature selection techniques, and utilizing optimized classification models for accurate and efficient OSA diagnosis.
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Affiliation(s)
- Alaa Sheta
- Computer Science Department, Southern Connecticut State University, New Haven, CT 06514, USA
| | - Thaer Thaher
- Department of Computer Systems Engineering, Arab American University, Jenin P.O. Box 240, Palestine
| | - Salim R Surani
- Department of Pulmonary, Critical Care & Sleep Medicine, Texas A&M University, College Station, TX 77843, USA
| | - Hamza Turabieh
- Health Management and Informatics Department, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Malik Braik
- Department of Computer Science, Al-Balqa Applied University, Salt 19117, Jordan
| | - Jingwei Too
- Faculty of Electrical Engineering, Universiti Teknikal Malaysia Melaka, Hang Tuah Jaya, Durian Tunggal 76100, Melaka, Malaysia
| | - Noor Abu-El-Rub
- Center of Medical Informatics and Enterprise Analytics, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Majdi Mafarjah
- Department of Computer Science, Birzeit University, Birzeit P.O. Box 14, Palestine
| | - Hamouda Chantar
- Faculty of Information Technology, Sebha University, Sebha 18758, Libya
| | - Shyam Subramanian
- Pulmonary, Critical Care & Sleep Medicine, Sutter Health, Tracy, CA 95376, USA
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2
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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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. BMC Pulm Med 2022; 22:396. [PMCID: PMC9632106 DOI: 10.1186/s12890-022-02200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
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.
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Fields BG. Exploring telemedicine evaluation reliability: ahead of its time and long overdue. J Clin Sleep Med 2021; 17:1337-1338. [PMID: 33928907 DOI: 10.5664/jcsm.9332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Barry G Fields
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Decatur, Georgia
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Oliveros H, Lobelo R, Giraldo-Cadavid LF, Bastidas A, Ballesteros C, Bernal R, Patiño L, Herrera K, Gozal D. BASAN index (Body mass index, Age, Sex, Arterial hypertension and Neck circumference) predicts severe apnoea in adults living at high altitude. BMJ Open 2021; 11:e044228. [PMID: 34168022 PMCID: PMC8231047 DOI: 10.1136/bmjopen-2020-044228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Obstructive sleep apnoea (OSA)/hypopnoea syndrome is associated with serious and major multiorgan morbidities, particularly in its most severe forms. However, no severe OSA screening instruments are available for high altitude residents that enable adequate identification and clinical prioritisation of such patients. We aimed at developing a severe OSA prediction tool based on the clinical characteristics and anthropometric measurements of a clinical referral cohort living at 2640 m.a.s.l. DESIGN Cohort-nested cross-sectional study. SETTING Sleep laboratory for standard polysomnography (PSG) in Colombia. PARTICIPANTS A predictive model was generated from 8718 participants referred to the PSG laboratory. Results were subsequently validated in a second cohort of 1898 participants. PRIMARY OUTCOME To identify clinical and anthropometric variables associated with severe OSA (>30 events/hour) and to include them in a binary logistic regression model. RESULTS The significant variables that were retained with the presence of severe OSA included Body mass index (BMI), Age, Sex, Arterial hypertension and Neck circumference (BASAN). The area under the receiver operating characteristic curvefor the BASAN index was 0.69 (95% CI: 0.68 to 0.70) in the derivation cohort and 0.67 (95% CI: 0.65 to 0.69) in the validation cohort, whereby a BASAN index ≥2 had a sensitivity of 95% and a specificity of 17% to detect severe OSA. CONCLUSION An objectively based approach to screen for the presence of severe OSA, the BASAN index, exhibits favourable sensitivity characteristics that should enable its operational use as a screening tool in a Hispanic population with a clinical suspicion of OSA and living at high altitude.
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Affiliation(s)
- Henry Oliveros
- School of Medicine, Epidemiology and Biostatistics Department, Universidad de La Sabana, Chia, Colombia
| | - Rafael Lobelo
- Pulmonary and Sleep Medicine - Grupo de Investigación en Sueño, CAYRE, Bogotá, D.C, Colombia
| | - Luis Fernando Giraldo-Cadavid
- School of Medicine, Epidemiology and Biostatistics Department, Universidad de La Sabana, Chia, Colombia
- Internal Medicine, Universidad de La Sabana, Chia, Colombia
- Interventional Pulmonology and Research Department, Fundacion Neumologica Colombiana, Bogotá, D.C, Colombia
| | - Alirio Bastidas
- School of Medicine, Epidemiology and Biostatistics Department, Universidad de La Sabana, Chia, Colombia
| | - Constanza Ballesteros
- Pulmonary and Sleep Medicine - Grupo de Investigación en Sueño, CAYRE, Bogotá, D.C, Colombia
| | - Rafael Bernal
- Pulmonary and Sleep Medicine - Grupo de Investigación en Sueño, CAYRE, Bogotá, D.C, Colombia
| | - Lilian Patiño
- Pulmonary and Sleep Medicine - Grupo de Investigación en Sueño, CAYRE, Bogotá, D.C, Colombia
| | - Karen Herrera
- Pulmonary and Sleep Medicine - Grupo de Investigación en Sueño, CAYRE, Bogotá, D.C, Colombia
| | - David Gozal
- Department of Child Health and the Children's Hospital Research Institute, University of Missouri, Columbia, Missouri, USA
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Chen R, Liu W, Cheng J, Zheng Z, Ba M, Peng M, He Q, Yang H, Chen T, Hong C. The No-apnea score vs. the other five questionnaires in screening for obstructive sleep apnea-hypopnea syndrome in patients with cerebral infarction. J Thorac Dis 2019; 11:4179-4187. [PMID: 31737301 DOI: 10.21037/jtd.2019.09.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Given the growing number of patients suspected of having obstructive sleep apnea-hypopnea syndrome (OSAHS), screening methods have become increasingly important for sleep clinics. We analyzed the clinical value of the No-apnea score which is used to diagnose OSAHS in patients with cerebral infarction, and compared the accuracy of the No-apnea score with the accuracy of the NoSAS score, the STOP-Bang questionnaire (SBQ), the Epworth Sleepiness Scale (ESS), the STOP questionnaire (STOP) and the Berlin questionnaire (BQ). Methods Between January 2014 and December 2018, a total of 221 cerebral infarction patients, suspected of having OSAHS, underwent the polysomnography (PSG) for one night at the sleep medical center of Guangdong Medical University Affiliated Second Hospital. The PSG data were collected and analyzed with the NoSAS score, the SBQ, the ESS, the STOP, the BQ, and patients' demographic information. Based on the apnea-hypopnea index (AHI), the patients were classified into four groups: the normal group (<5 events/h), mild OSAHS group (5-15 events/h), moderate OSAHS group (15-30 events/h) and severe OSAHS group (≥30 events/h). The sensitivity, specificity, positive predictive value, negative predictive value and areas under the curve (AUC) of the Receiver Operating Curve (ROC) were calculated for the five questionnaires to compare their relative efficacies for diagnosing OSAHS. Results When using the standard of AHI ≥5 for diagnosing OSAHS, the NoSAS score had an AUC of 0.831; the SBQ had an AUC of 0.730; the BQ had an AUC of 0.698; and the STOP had an AUC of 0.735, so these techniques are relatively accurate in diagnosing OSAHS. On the other hand, the No-apnea score and the ESS score are relatively less accurate comparing to the rest: the No-apnea had an AUC of 0.626, and the ESS had an AUC of 0.650. Using the NoSAS score to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI ≥30 events/h, the sensitivity and specificity were 0.867 and 0.731, 0.888 and 0.476, 0.889 and 0.369, respectively; Using the SBQ to predict AHI ≥5 events/h, AHI 15 events/h and AHI ≥30 events/h, the sensitivity and specificity were 0.903 and 0.268, 0.914 and 0.200, 0.903 and 0.268, respectively; Using the STOP to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI ≥30 events/h, the values were 0.830 and 0.500, 0.871 and 0.390, 0.875 and 0.302, respectively; and using the BQ to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI ≥30 events/h, the values were 0.758 and 0.482, 0.810 and 0.429, 0.819 and 0.362, respectively. Conclusions The study concludes that the NoSAS score and the SBQ had a better predictive value for cerebral infarction patients suspected with OSAHS disease. These questionnaires can also effectively help clinicians quickly address nocturnal hypoxia in patients with cerebral infarction to control subsequent complications in patients with cerebral infarction. More studies are needed to evaluate the efficacy of the NoSAS score in screening for OSAHS in patients with cerebral infarction.
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Affiliation(s)
- Riken Chen
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Wang Liu
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Junfen Cheng
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Zhenzhen Zheng
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Manqing Ba
- Department of Biochemistry and Chemistry, The University of Arizona, Tucson, AR, USA
| | - Min Peng
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Qizhong He
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Huajing Yang
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Tao Chen
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Cheng Hong
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
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Gamaldo C, Buenaver L, Chernyshev O, Derose S, Mehra R, Vana K, Walia HK, Gonzalez V, Gurubhagavatula I. Evaluation of Clinical Tools to Screen and Assess for Obstructive Sleep Apnea. J Clin Sleep Med 2018; 14:1239-1244. [PMID: 29991434 DOI: 10.5664/jcsm.7232] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/09/2018] [Indexed: 11/13/2022]
Abstract
ABSTRACT Obstructive sleep apnea (OSA) is a globally recognized medical condition, associated with development of long-term adverse health consequences, including cardiovascular disease, cerebrovascular disease, neurocognitive deficiencies, and vehicular and occupational accidents. OSA can be screened effectively, because it can be identified well before the manifestation of the aforementioned poor health and public safety consequences. Additionally, appropriate management of OSA includes an assessment of outcomes before and after therapeutic intervention initiation. OSA clinical screening and outcome assessment tools exist; however, a key existing knowledge gap is identifying which tools are most clinically relevant and efficient to use in clinical practice models. The American Academy of Sleep Medicine (AASM) commissioned a task force (TF) of sleep medicine experts to identify and evaluate current OSA screening and assessment tools for adult patients and determine if they are reliable, effective, and feasible for use in clinical settings. No single tool met all the TF's objective criteria and subjective evaluation for clinical validity and feasibility to be recommended by the AASM. The TF provides several suggestions for the development of new tools or modifications to existing tools that would enhance their functionality in adults.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Indira Gurubhagavatula
- University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
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8
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Validity of the Berlin questionnaire in detecting obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2017; 36:116-124. [PMID: 28599983 DOI: 10.1016/j.smrv.2017.04.001] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 01/06/2023]
Abstract
We aimed to systematically review the Berlin questionnaire as a screening tool for obstructive sleep apnea. We systematically searched PubMed, Embase, and Scopus databases, reviewed articles reporting the Berlin questionnaire's diagnostic utility as measured against type-1 polysomnography, and performed meta-analyses where possible. Thirty five eligible articles showed that the Berlin questionnaire's diagnostic utility varied by study population, definition of hypopnea used, and apnea-hypopnea index threshold used. It had good sensitivity and specificity for detecting clinically relevant obstructive sleep apnea as well as any obstructive sleep apnea in the sleep clinic population. Despite limited evidence, it showed modest to high sensitivity for detecting clinically relevant obstructive sleep apnea or any obstructive sleep apnea in other clinical and general population subgroups. Its specificity was relatively low. Possible reasons for variability in reported diagnostic utility of the Berlin questionnaire are multifaceted. We conclude that the Berlin questionnaire is useful as a clinical screening test and epidemiological tool in the sleep clinic population. Despite limited evidence, it likely has potential clinical and research utility in other populations. Adopting more consistent methodological definitions and focussing more on the general population and specific clinical populations to determine its usefulness as a clinical or epidemiological screening tool are recommended.
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9
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Tan A, Yin JDC, Tan LWL, van Dam RM, Cheung YY, Lee CH. Using the Berlin Questionnaire to Predict Obstructive Sleep Apnea in the General Population. J Clin Sleep Med 2017; 13:427-432. [PMID: 27855742 DOI: 10.5664/jcsm.6496] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/18/2016] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVES The Berlin questionnaire is a self-administered questionnaire that was developed to identify subjects with obstructive sleep apnea (OSA) in primary care settings. This study evaluated the performance of the questionnaire to predict OSA in the general population. METHODS A sample of 242 subjects in a population-based cohort completed a home-based sleep study with an Embletta device (type 3 monitor). Subjects completed the Berlin questionnaire on the evening just prior to the sleep study. The sleep studies were manually scored according to the 2012 American Academy of Sleep Medicine (AASM) criteria. RESULTS The prevalence of moderate-to-severe and severe OSA defined as apnea-hypopnea index (AHI) of ≥ 15 and ≥ 30 was 28.1% and 10.7%, respectively. Seventy-nine subjects (32.6%) were classified as high risk according to the Berlin questionnaire. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the questionnaire to predict an AHI ≥ 15 was 58.8%, 77.6%, 82.9%, and 50.6%, respectively. The area under the receiving operator characteristic (ROC) curve for moderate-to-severe OSA was 0.682. When used to predict an AHI ≥ 30, the sensitivity of the questionnaire increased to 76.9% with a small drop in specificity to 72.7%. The corresponding NPV, PPV, and area under the ROC curve of the questionnaire to predict severe OSA were 96.3%, 25.3%, and 0.748, respectively. CONCLUSIONS The Berlin questionnaire may have utility in the general population setting as a screening tool for OSA in view of its good sensitivity and high NPV in ruling out severe OSA.
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Affiliation(s)
- Adeline Tan
- Department of Respiratory Medicine, Ng Teng Fong General Hospital, Jurong Health Services, Singapore
| | - Jason D C Yin
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System
| | - Linda W L Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System
| | - Yan Yi Cheung
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System.,Department of Cardiology, National University Heart Centre, Singapore
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System.,Department of Cardiology, National University Heart Centre, Singapore
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506-- or] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506\] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13:479-504. [PMID: 28162150 DOI: 10.5664/jcsm.6506] [Citation(s) in RCA: 1519] [Impact Index Per Article: 217.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506;] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506" or "" = "] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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15
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506"] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2017. [PMID: 28162150 DOI: 10.5664/jcsm.6506,] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. METHODS The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
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Affiliation(s)
| | - Dennis H Auckley
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
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Surani SR, Varon J. Perioperative screening for obstructive sleep apnoea and treatment outcomes: where are the data? Eur Respir J 2016; 48:21-2. [PMID: 27365506 DOI: 10.1183/13993003.00470-2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/23/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Salim R Surani
- Dept of Medicine, Texas A&M University, Aransas Pass, TX, USA
| | - Joseph Varon
- The University of Texas Health Science Center at Houston, Houston, TX, USA The University of Texas Medical Branch at Galveston, Houston, TX, USA
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Westerlund A, Brandt L, Harlid R, Åkerstedt T, Lagerros YT. Using the Karolinska Sleep Questionnaire to identify obstructive sleep apnea syndrome in a sleep clinic population. CLINICAL RESPIRATORY JOURNAL 2015; 8:444-54. [PMID: 25396257 DOI: 10.1111/crj.12095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In Scandinavia, portable monitoring has virtually replaced standard polysomnography for diagnosis of obstructive sleep apnea syndrome (OSAS). Because waiting times for specialized OSAS care remain long, an accurate screening tool to exclude low-risk patients from diagnostic testing would be valuable. OBJECTIVES To examine the diagnostic accuracy of the Karolinska Sleep Questionnaire (KSQ) for OSAS. METHODS Consecutive patients, 30–66 years old, attending a large sleep clinic in Sweden for OSAS evaluation completed the KSQ and underwent in-home portable monitoring and medical history evaluation. OSAS was defined as apnea-hypopnea index ≥5 with symptoms of disease. We calculated sensitivity and specificity of apnea/snoring and sleepiness indices of the KSQ. Retrospectively, we combined six KSQ items (snoring, breathing cessations, disturbed sleep, etc.) and four clinical variables (age, sex, body mass index, smoking status) predictive of OSAS into a new instrument, which we also evaluated. Instrument score ranged between 0 and 21; a higher score indicated more severe symptoms. RESULTS Of 103 patients, 62 were diagnosed with OSAS. Sensitivity and specificity of the indices were 0.56 and 0.68 (apnea/snoring), and 0.37 and 0.71 (sleepiness). The new instrument performed optimally at a score of 9. Sensitivity was 0.76 (95% confidence interval 0.63–0.86) and specificity 0.88 (0.74–0.96). Between 19.4% and 50.5% of patients were unaware of having apnea/snoring symptoms. CONCLUSIONS Diagnostic accuracy of the apnea/snoring and sleepiness indices for OSAS was poor but could be improved by combining clinical and KSQ items. The usefulness of the apnea/snoring index and the combined instrument was questionable because of extensive symptom unawareness.
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Alruwaili H, Ahmed A, Fatani A, Al-Otaibi K, AL-Jahdali S, Ali Y, Al-Harbi A, Baharoon S, Khan M, AL-Jahdali H. Symptoms and risk for obstructive sleep apnea among sample of Saudi Arabian adults. Sleep Biol Rhythms 2015. [DOI: 10.1111/sbr.12124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hind Alruwaili
- King Abdullah International Medical Research Center/Department of Epidemiology and Biostatistics; College of Public Health and Health Informatics; King Saud University for Health Sciences; Riyadh Saudi Arabia
| | - Anwar Ahmed
- King Abdullah International Medical Research Center/Department of Epidemiology and Biostatistics; College of Public Health and Health Informatics; King Saud University for Health Sciences; Riyadh Saudi Arabia
| | - Abdulhamid Fatani
- College of Medicine; King Saud University for Health Sciences; Riyadh Saudi Arabia
| | - Khalid Al-Otaibi
- College of Medicine; King Saud University for Health Sciences; Riyadh Saudi Arabia
| | - Sarah AL-Jahdali
- College of Medicine; King Saud University for Health Sciences; Riyadh Saudi Arabia
| | - Yosra Ali
- College of Medicine; King Saud University for Health Sciences; Riyadh Saudi Arabia
| | - Abdullah Al-Harbi
- Department of Medicine; Pulmonary Division-ICU; Sleep Disorders Center; King Saud University for Health Sciences; Riyadh Saudi Arabia
| | - Salim Baharoon
- Department of Medicine; Pulmonary Division-ICU; Sleep Disorders Center; King Saud University for Health Sciences; Riyadh Saudi Arabia
| | - Mohammad Khan
- Department of Medicine; Pulmonary Division-ICU; Sleep Disorders Center; King Saud University for Health Sciences; Riyadh Saudi Arabia
| | - Hamdan AL-Jahdali
- Department of Medicine; Pulmonary Division-ICU; Sleep Disorders Center; King Saud University for Health Sciences; Riyadh Saudi Arabia
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Selim BJ, Surani SR, Ramar K. Role of preoperative screening for adult patients for obstructive sleep apnea. Hosp Pract (1995) 2015; 42:100-7. [PMID: 25485922 DOI: 10.3810/hp.2014.12.1163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Obstructive sleep apnea (OSA) is a chronic disease with increasing prevalence. Underdiagnosed in the surgical population, OSA can reach a prevalence of up to 70% in bariatric surgery, and be associated with difficult airways and postoperative cardiopulmonary adverse events. Despite its association with escalation of care, increased health care resource utilization, and length of hospital stay, < 25% of health care institutions in the United States have OSA perioperative protocols to improve patient safety. This is explained in part by a lack of studies that support a widely accepted systematic approach to preoperative screening and risk stratification. This review evaluates the role of preoperative screening tools for adult patients with suspected OSA.
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Affiliation(s)
- Bernardo J Selim
- Assistant Professor in Medicine, Mayo Clinic Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, MN
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Lipford MC, Ramar K, Surani SR. Obstructive sleep apnea in the perioperative setting: complications and management strategies. Hosp Pract (1995) 2015; 43:56-63. [PMID: 25559851 DOI: 10.1080/21548331.2015.1001709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA) is frequently encountered in an undiagnosed, untreated state in perioperative patients. It increases the risk of respiratory, cardiac, and infectious complications following surgical procedures. Patients with OSA may require additional monitoring, unplanned escalations in care, and prolonged hospitalization. It is important to identify patients at risk for OSA during the preoperative assessment so that appropriate anesthesia, postsurgical monitoring, and pain control can be planned. Herein, we discuss data regarding perioperative outcomes in patients with OSA, methods to quickly identify patients at high risk for OSA, and implementation of clinical safeguards to minimize OSA-associated complications. An algorithm is provided to guide the perioperative management of patients with OSA.
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Affiliation(s)
- Melissa C Lipford
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic , Rochester, MN
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Surani SR. Diabetes, sleep apnea, obesity and cardiovascular disease: Why not address them together? World J Diabetes 2014; 5:381-384. [PMID: 24936259 PMCID: PMC4058742 DOI: 10.4239/wjd.v5.i3.381] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/01/2014] [Accepted: 05/16/2014] [Indexed: 02/05/2023] Open
Abstract
Obesity, sleep apnea, diabetes and cardiovascular diseases are some of the most common diseases encountered by the worldwide population, with high social and economic burdens. Significant emphasis has been placed on obtaining blood pressure, body mass index, and placing importance on screening for signs and symptoms pointing towards cardiovascular disease. Symptoms related to sleep, or screening for sleep apnea has been overlooked by cardiac, diabetic, pulmonary and general medicine clinics despite recommendations for screening by several societies. In recent years, there is mounting data where obesity and obstructive sleep apnea sit at the epicenter and its control can lead to improvement and prevention of diabetes and cardiovascular complications. This editorial raises questions as to why obstructive sleep apnea screening should be included as yet another vital sign during patient initial inpatient or outpatient visit.
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Surani S. Are diabetic patients being screened for sleep related breathing disorder? World J Diabetes 2013; 4:162-164. [PMID: 24147199 PMCID: PMC3797880 DOI: 10.4239/wjd.v4.i5.162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/22/2013] [Accepted: 08/17/2013] [Indexed: 02/05/2023] Open
Abstract
Prevalence of both diabetes mellitus and obstructive sleep apnea (OSA) is high among general population. Both of these conditions are associated with significant morbidity. OSA affects approximately 25% of men and 9% of women, and its prevalence is even higher among obese, Hispanics, African American and diabetic patients. Diabetes on the other hand besides having high prevalence in general population has even higher prevalence among ethnic populations as Hispanics and African American. Despite the availability of several simple screening tools for OSA, as Berlin questionnaire, STOP-BANG questionnaire, NAMES Criteria, the utility for screening of OSA among the diabetic population remains marginal. This in turn can lead to significant morbidity and complications related to OSA as well as worsening of diabetes mellitus and increase in diabetic complications due to untreated sleep related breathing disorder. It is therefore imperative for the primary care giver to screen for OSA among the diabetic population as a part of their routine evaluation to prevent worsening of diabetes, and its cardiovascular, renal, ophthalmologic and neurological complications.
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Influence of gender and anthropometric measures on severity of obstructive sleep apnea. Sleep Breath 2011; 16:1091-5. [PMID: 22033627 DOI: 10.1007/s11325-011-0607-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 09/08/2011] [Accepted: 10/11/2011] [Indexed: 02/05/2023]
Abstract
PURPOSE Gender differences influence upper airway anatomy and physiology. The purpose of our study was to evaluate the influence of gender as well as anthropometric measures on severity of obstructive sleep apnea (OSA). METHODS A retrospective review of patients referred to our sleep laboratory for evaluation of OSA was done. Patients with a diagnosis of OSA (Respiratory Disturbance Index (RDI) > 5) were included in the study. Anthropometric measurements were available for all the patients included in the study. Measurements of subjects' height, weight, neck size, and waist and hip sizes were used in the study; waist-hip ratio and neck-to-height ratio were calculated. RESULTS Three hundred eighty-six females and 661 males were included. Women were older than men and had a higher body mass index (BMI) and waist-to-hip ratio; men had a thicker neck circumference and a higher neck-to-height ratio. The severity of OSA was significantly higher in males (RDI 41.2 ± 27.9 in men vs. 30.0 ± 26.7 in women, p < 0.0001) despite a lower BMI and age in the men. Severity of OSA, as measured by RDI, varied significantly with changes in anthropometric measures such as neck circumference, and waist and hip sizes in both genders. Waist-to-hip ratio was associated with severity of OSA in men but not in women (p = 0.19 and 0.0001 in women and men, respectively). However, no single anthropometric value was found to be strongly predictive of OSA severity. CONCLUSION Despite having a higher mean BMI and age, women have lower RDI compared with men. Waist-to-hip ratio is more predictive of severity of OSA in men than in women. However, the correlation of anthropometric measures with severity of OSA was weak in our subjects.
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Pecotic R, Dodig IP, Valic M, Ivkovic N, Dogas Z. The evaluation of the Croatian version of the Epworth sleepiness scale and STOP questionnaire as screening tools for obstructive sleep apnea syndrome. Sleep Breath 2011; 16:793-802. [DOI: 10.1007/s11325-011-0578-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 07/26/2011] [Accepted: 08/15/2011] [Indexed: 02/01/2023]
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