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Peñacoba P, Llauger MA, Fortuna AM, Flor X, Sampol G, Pedro-Pijoan AM, Grau N, Santiveri C, Juvanteny J, Aoiz JI, Bayó J, Lloberes P, Mayos M. A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study. BMC Pulm Med 2022; 22:38. [PMID: 35033055 PMCID: PMC8761286 DOI: 10.1186/s12890-022-01827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
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://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979. Date of registration: October 30, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01827-0.
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Affiliation(s)
- Patricia Peñacoba
- Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Maria Antònia Llauger
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Equip d'Atenció Primària Encants, Centre d'Atenció Primària (CAP) Maragall, Institut Català de La Salut, Barcelona, Spain
| | - Ana María Fortuna
- Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Flor
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Chafarinas, Institut Català de La Salut, Barcelona, Spain
| | - Gabriel Sampol
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
| | | | - Núria Grau
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain.,Sleep Unit, Department of Respiratory Medicine, Parc de Salut Mar-IMIM, Hospital del Mar, Barcelona, Spain
| | - Carme Santiveri
- Service of Pneumology, Hospital Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain
| | - Joan Juvanteny
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Trinitat Vella, Institut Català de La Salut, Barcelona, Spain
| | | | - Joan Bayó
- CAP El Clot, Institut Català de La Salut, Barcelona, Spain
| | - Patricia Lloberes
- Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
| | - Mercè Mayos
- Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
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Patel D, Tsang J, Saripella A, Nagappa M, Islam S, Englesakis M, Chung F. Validation of the STOP questionnaire as a screening tool for OSA among different populations: a systematic review and meta-regression analysis. J Clin Sleep Med 2021; 18:1441-1453. [PMID: 34910625 PMCID: PMC9059595 DOI: 10.5664/jcsm.9820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a sleep breathing disorder associated with adverse health outcomes, but it remains largely underdiagnosed. The STOP questionnaire is a simple tool for screening OSA and is widely used in various populations. The objective of this study was to determine the predictive parameters of the STOP questionnaire to detect OSA in sleep clinics, medical population, surgical population, commercial drivers, and the general population. METHODS Electronic databases were searched from January 2008 to April 2021. Pooled predictive parameters were recalculated using 2 × 2 contingency tables and random-effects meta-analyses were performed. The combined test characteristics at different OSA severities [any OSA (AHI≥5), moderate-to-severe OSA (AHI≥15), severe OSA (AHI≥30)] were used to compare the accuracy of the STOP questionnaire with polysomnography. The quality of the studies was evaluated using Cochrane Methods criteria. RESULTS Twenty-four studies met the inclusion criteria: 16 were in the sleep clinic population (n=8,132), four in medical population (n=1,023), two in the surgical population (n=258), and one study each on commercial drivers (n=85) and general population (n=4,770). A STOP score ≥2 showed excellent sensitivity to the different OSA severities for the sleep clinic population (>89%) and to severe OSA for the medical population (85.6%). In both populations, the STOP questionnaire also had excellent discriminative power to exclude severe OSA [negative predictive values (NPV) >84%]. The pooled sensitivity and NPV for the surgical population with moderate-to-severe OSA was 81% and 75%. CONCLUSIONS This meta-analysis suggests that the STOP questionnaire is a valid and effective screening tool for OSA among these population.
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Affiliation(s)
- Darshit Patel
- UCD School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Jinny Tsang
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Mahesh Nagappa
- Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sazzadul Islam
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Peñacoba P, Llauger MA, Fortuna AM, Flor X, Sampol G, Pedro Pijoan AM, Grau N, Santiveri C, Juvanteny J, Aoiz JI, Bayó J, Lloberes P, Mayos M. Primary care and sleep unit agreement in management decisions for sleep apnea: a prospective study in Spain. J Clin Sleep Med 2021; 16:1579-1589. [PMID: 32279702 DOI: 10.5664/jcsm.8492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVES Involvement of primary care teams in the care of patients with OSA is a focus of interest. The study objective was to compare diagnostic and therapeutic agreement between decisions taken by primary care professionals and sleep unit specialists. METHODS This was a prospective multicenter study conducted at primary care and specialized care centers in the urban area of Barcelona, Spain. Men and women aged 18-75 years who visited the participating primary care centers for any reason were recruited. Both primary care physicians and sleep specialists made a diagnostic and therapeutic decision with clinical data and results of a home sleep apnea test. All patients were finally assessed with respiratory polygraphy or polysomnography as a gold-standard test. RESULTS A total of 229 patients underwent a home sleep apnea test and were evaluated at the primary care centers and the sleep units. Diagnostic agreement using the same tools and excluding indeterminate decisions was 69.8% (Cohen's kappa = 0.64; 95% confidence interval, 0.56-0.72). Agreement for therapeutic decisions (PAP vs conservative treatment) was obtained in 82.5% of patients (Cohen's kappa = 0.62; 95% confidence interval, 0.51-0.73), increasing to 92.5% (Cohen's kappa = 0.49, 95% confidence interval, 0.40-0.58) when indeterminate options were excluded. As compared with the final therapeutic decisions made at the sleep unit with respiratory polygraphy/polysomnography, primary care physicians agreed regarding 83.3% (Cohen's kappa = 0.62; 95% confidence interval, 0.49-0.74) of patients. CONCLUSIONS Primary care professionals may assume an important role in the management of OSA in coordination with sleep centers, identifying patients who require specific treatment and should be referred to specialized care. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979.
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Affiliation(s)
- Patricia Peñacoba
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Antònia Llauger
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Equip d'Atenció Primària Encants, Centre d'Atenció Primària (CAP) Maragall, Institut Català de la Salut, Barcelona, Spain
| | - Ana M Fortuna
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Flor
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Chafarinas, Institut Català de la Salut, Barcelona, Spain
| | - Gabriel Sampol
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain
| | | | - Núria Grau
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain.,Sleep Unit, Department of Respiratory Medicine, Parc de Salut Mar-IMIM, Hospital del Mar, Barcelona, Spain
| | - Carme Santiveri
- Service of Pneumology, Hospital Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain
| | - Joan Juvanteny
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Trinitat Vella, Institut Català de la Salut, Barcelona, Spain
| | | | - Joan Bayó
- CAP El Clot, Institut Català de la Salut, Barcelona, Spain
| | - Patricia Lloberes
- Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain
| | - Mercè Mayos
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain
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Awopeju OF, Fawale MB, Olowookere SA, Salami OT, Adewole OO, Erhabor GE. The risk of obstructive sleep apnea and its association with indices of general and abdominal obesity in a Nigerian family practice clinic: a cross-sectional study. ALEXANDRIA JOURNAL OF MEDICINE 2020. [DOI: 10.1080/20905068.2019.1711304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Michael Bimbo Fawale
- Neurology unit, Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Samuel Anu Olowookere
- Department of Family Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
- Department of Community Health, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Oluwasina Titus Salami
- Department of Family Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | | | - Gregory Efosa Erhabor
- Respiratory unit, Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria
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Coordinated program between primary care and sleep unit for the management of obstructive sleep apnea. NPJ Prim Care Respir Med 2019; 29:39. [PMID: 31704942 PMCID: PMC6841945 DOI: 10.1038/s41533-019-0151-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study is to develop and validate a work model in the primary health-care setting for identifying patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) based on clinical variables and an ambulatory sleep monitoring study. After screening, patients with mild–moderate OSAHS could be managed by primary care physicians, whereas those identified with severe OSAHS would be referred to specialists from sleep units for starting specific treatment. The proposed model does not move the entire health-care process to a generally overburdened primary care level and favors the coordinated work and the necessary flexibility to adapt the model to challenges and perspectives of OSAHS.
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7
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Suarez-Giron M, Bonsignore MR, Montserrat JM. New organisation for follow-up and assessment of treatment efficacy in sleep apnoea. Eur Respir Rev 2019; 28:28/153/190059. [PMID: 31511256 PMCID: PMC9488453 DOI: 10.1183/16000617.0059-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/16/2019] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is a highly prevalent disease, and there is an increased demand for OSA diagnosis and treatment. However, resources are limited compared with the growing needs for OSA diagnosis and management, and alternative strategies need to be developed to optimise the OSA clinical pathway. In this review, we propose a management strategy for OSA, and in general for sleep-disordered breathing, to be implemented from diagnosis to follow-up. For this purpose, the best current options seem to be: 1) networking at different levels of care, from primary physicians to specialised sleep laboratories; and 2) use of telemedicine. Telemedicine can contribute to the improved cost-effectiveness of OSA management during both the diagnostic and therapeutic phases. However, although the technology is already in place and different commercial platforms are in use, it is still unclear how to use telemedicine effectively in the sleep field. Application of telemedicine for titration of positive airway pressure treatment, follow-up to improve compliance to treatment through early identification and solution of problems, and teleconsultation all appear to be promising areas for improved OSA management. Telemedicine could improve the management of sleep apnoea and other breathing disorders during sleep.http://bit.ly/2XPoPW1
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8
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Graco M, Berlowitz DJ, Green SE. Understanding the clinical management of obstructive sleep apnoea in tetraplegia: a qualitative study using the theoretical domains framework. BMC Health Serv Res 2019; 19:405. [PMID: 31226999 PMCID: PMC6588842 DOI: 10.1186/s12913-019-4197-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend further testing for people with tetraplegia and signs and symptoms of obstructive sleep apnoea (OSA), followed by treatment with positive airway pressure therapy. Little is known about how clinicians manage OSA in tetraplegia. The theoretical domains framework (TDF) is commonly used to identify determinants of clinical behaviours. This study aimed to describe OSA management practices in tetraplegia, and to explore factors influencing clinical practice. METHODS Semi-structured interviews were conducted with 20 specialist doctors managing people with tetraplegia from spinal units in Europe, UK, Canada, USA, Australia and New Zealand. Interviews were audiotaped for verbatim transcription. OSA management was divided into screening, diagnosis and treatment components for inpatient and outpatient services, allowing common practices to be categorised. Data were thematically coded to the 12 constructs of the TDF. Common beliefs were identified and comparisons were made between participants reporting different practices. RESULTS Routine screening for OSA signs and symptoms was reported by 10 (50%) doctors in inpatient settings and eight (40%) in outpatient clinics. Doctors commonly referred to sleep specialists for OSA diagnosis (9/20 in inpatients; 16/20 in outpatients), and treatment (12/20, 17/20). Three doctors reported their three spinal units were managing non-complicated OSA internally, without referral to sleep specialists. Ten belief statements representing six domains of the TDF were generated about screening. Lack of time and support staff (Environmental context and resources) and no prompts to screen for OSA (Memory, attention and decision processes) were commonly identified barriers to routine screening. Ten belief statements representing six TDF domains were generated for diagnosis and treatment behaviours. Common barriers to independent management practices were lack of skills (Skills), low confidence (Beliefs about capabilities), and the belief that OSA management was outside their scope of practice (Social/Professional role and identity). The three units independently managing OSA were well resourced with multidisciplinary involvement (Environmental context and resources), had 'clinical champions' to lead the program (Social influences). CONCLUSION Clinical management of OSA in tetraplegia is highly varied. Several influences on OSA management within spinal units have been identified, facilitating the development of future interventions aiming to improve clinical practice.
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Affiliation(s)
- Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria Australia
| | - David J. Berlowitz
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria Australia
| | - Sally E. Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
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9
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Toraldo DM, Passali D, Sanna A, De Nuccio F, Conte L, De Benedetto M. Cost-effectiveness strategies in OSAS management: a short review. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:447-453. [PMID: 28663598 PMCID: PMC5782420 DOI: 10.14639/0392-100x-1520] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/11/2017] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnoea (OSAS) is an underdiagnosed chronic disease with a high prevalence in adults. It is becoming a significant social problem, since it is associated with a worsening in quality of life and increase in mortality. The cost-effectiveness ratio of diagnostic and therapeutic management of OSAS is a strategic issue to counteract the expected increasing demand of objective testing. OSAS patients with any clinical evidence of comorbidities must be studied using simplified and less expensive systems such as Home Sleep Testing (HST). On the other hand, Sleep Laboratory Polysomnography (PSG) is the gold standard to manage OSAS patients with comorbidities. It should be pointed out that the use of HST can lead to incorrect diagnosis in poorly selected OSAS subjects. This short review discusses various topics for the proper diagnosis and treatment of OSAS in view of epidemiological factors and results in terms of costs and social benefit of the disease. Whatever the strategy chosen and/or the organisational model adopted for managing OSAS, it cannot and should not take into account only cost-effectiveness. Long-term prospective studies evaluating cost-effectiveness ratios and outcomes of OSAS treatment of hospital management models versus home care models are needed.
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Affiliation(s)
- D M Toraldo
- Hospital Rehabilitation, Dept Cardio-Respiratory Care Unit, "V Fazzi", ASL Lecce, Italy
| | - D Passali
- ENT Clinic, University of Siena, Italy
| | - A Sanna
- Pneumology Unit, San Jacopo Hospital, Azienda USL Toscana Centro, Pistoia, Italy
| | - F De Nuccio
- Laboratory of Human Anatomy and Neuroscience, Dept. of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - L Conte
- Laboratory of Interdisciplinary Research Applied to Medicine (DReAM), University of Salento at the Hospital "V Fazzi", ASL Lecce, Italy
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[Diagnostic accuracy of STOP-Bang questionnaire on moderate sleep apnoea in primary care]. GACETA SANITARIA 2018; 33:421-426. [PMID: 30033095 DOI: 10.1016/j.gaceta.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to compare the diagnostic utility of the STOP-Bang questionnaire for moderate apnoea against the gold standard (type I polysomnography) in a primary care setting. METHOD Study of diagnostic utility in primary care. Estimated sample: 85 cases and 85 healthy controls. In convenience sampling, 203 patients were recruited by their physicians at six health centres. Twenty-five were excluded, and 57 women and 121 men, of whom 74 had apnoea-hypopnoea index (AHI) ≥15, were analyzed. STOP-Bang was validated by comparing scores in the same patient with the apnoea-hypopnoea index observed in polysomnography, as a gold standard. Sample size, ROC curve analysis and optimal cut-off points were identified with the easyROC, pROC, and OptimalCutpoints packages. RESULTS The area under the curve in moderate apnoea (AHI ≥15) of the STOP-Bang was 0.777 (0.667-0.808), with optimal cut-off points different by sex (4 in women and 6 in men). In the cross-validation with k=10, the area under the curve for the STOP-Bang was 0.678. CONCLUSIONS The STOP-Bang presents a diagnostic moderate utility for AHI≥15, but superior to other scales, in a community population. Its performance is more appropriate in women.
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11
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Graco M, Schembri R, Cross S, Thiyagarajan C, Shafazand S, Ayas NT, Nash MS, Vu VH, Ruehland WR, Chai-Coetzer CL, Rochford P, Churchward T, Green SE, Berlowitz DJ. Diagnostic accuracy of a two-stage model for detecting obstructive sleep apnoea in chronic tetraplegia. Thorax 2018; 73:864-871. [PMID: 29735608 DOI: 10.1136/thoraxjnl-2017-211131] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/22/2018] [Accepted: 04/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is highly prevalent in people with spinal cord injury (SCI). Polysomnography (PSG) is the gold-standard diagnostic test for OSA, however PSG is expensive and frequently inaccessible, especially in SCI. A two-stage model, incorporating a questionnaire followed by oximetry, has been found to accurately detect moderate to severe OSA (MS-OSA) in a non-disabled primary care population. This study investigated the accuracy of the two-stage model in chronic tetraplegia using both the original model and a modified version for tetraplegia. METHODS An existing data set of 78 people with tetraplegia was used to modify the original two-stage model. Multivariable analysis identified significant risk factors for inclusion in a new tetraplegia-specific questionnaire. Receiver operating characteristic (ROC) curve analyses of the questionnaires and oximetry established thresholds for diagnosing MS-OSA. The accuracy of both models in diagnosing MS-OSA was prospectively evaluated in 100 participants with chronic tetraplegia across four international SCI units. RESULTS Injury completeness, sleepiness, self-reported snoring and apnoeas were included in the modified questionnaire, which was highly predictive of MS-OSA (ROC area under the curve 0.87 (95% CI 0.79 to 0.95)). The 3% oxygen desaturation index was also highly predictive (0.93 (0.87-0.98)). The two-stage model with modified questionnaire had a sensitivity and specificity of 83% (66-93) and 88% (75-94) in the development group, and 77% (65-87) and 81% (68-90) in the validation group. Similar results were demonstrated with the original model. CONCLUSION Implementation of this simple alternative to full PSG could substantially increase the detection of OSA in patients with tetraplegia and improve access to treatments. TRIAL REGISTRATION NUMBER Results, ACTRN12615000896572 (The Australian and New Zealand Clinical Trials Registry) and pre-results, NCT02176928 (clinicaltrials.gov).
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Affiliation(s)
- Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Schembri
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Susan Cross
- National Spinal Injuries Centre, Stoke-Mandeville Hospital, Aylesbury, UK
| | | | - Shirin Shafazand
- Miller School of Medicine, The University of Miami, Miami, Florida, USA
| | - Najib T Ayas
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark S Nash
- Miller School of Medicine, The University of Miami, Miami, Florida, USA
| | - Viet H Vu
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Spinal Cord Injury Department, GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
| | - Warren R Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.,Sleep Health Service, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Peter Rochford
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Thomas Churchward
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Sally E Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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Mineiro MA, Silva PMD, Alves M, Papoila AL, Marques Gomes MJ, Cardoso J. The role of sleepiness on arterial stiffness improvement after CPAP therapy in males with obstructive sleep apnea: a prospective cohort study. BMC Pulm Med 2017; 17:182. [PMID: 29221483 PMCID: PMC5723049 DOI: 10.1186/s12890-017-0518-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/23/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk. This study aim to assess differences in changes in arterial stiffness of two groups of patients, defined as having daytime sleepiness or not, after continuous positive airway pressure (CPAP) treatment. METHODS A selected cohort of consecutive male patients, under 65 years old, with moderate to severe OSA and without great number of comorbidities was studied. The diagnosis was confirmed by home respiratory poligraphy. Sleepiness was considered with an Epworth Sleepiness Scale (ESS) > 10. An ambulatory blood pressure (BP) monitoring and carotid-femoral pulse wave velocity (cf-PWV) measurements were performed, before and after four months under CPAP. Compliant patients, sleepy and non-sleepy, were compared using linear mixed effects regression models. A further stratified analysis was performed with non-sleepy patients. RESULTS Thirty-four patients were recruited, with mean age 55.2 (7.9) years, 38.2% were sleepy, 79.4% with hypertension, 61.8% with metabolic syndrome and 82.4% with dyslipidaemia. In univariable analysis, cf-PWV was strongly related to systolic BP parameters and age, but also to antihypertensive drugs (p = 0.030), metabolic syndrome (p = 0.025) and daytime sleepiness (p = 0.004). Sleepy patients had a more severe OSA, with AHI 44.8 (19.0) vs 29.7 (15.7) events/h (p = 0.018), but sleep study parameters were not associated with cf-PWV values. On multivariable regression, a significant interaction between time (CPAP) and sleepiness (p = 0.033) was found. There was a weak evidence of a cf-PWV reduction after CPAP treatment (p = 0.086), but the effects of treatment differed significantly between groups, with no changes in non-sleepy patients, while in sleepy patients a significant decrease was observed (p = 0.012). Evaluating non-sleepy patients group under CPAP therapy, results showed that both higher pulse pressure (p = 0.001) and lower LDL-cholesterol levels (p = 0.015) at baseline were associated to higher cf-PWV changes. CONCLUSIONS Patients with daytime sleepiness had a more severe OSA and presented a greater arterial stiffness improvement after CPAP therapy, independently from age and BP. Besides sleepiness, cf-PWV reduction after CPAP therapy was mainly associated to CV risk factors, and less to sleep study parameters. TRIAL REGISTRATION Clinicaltrials.gov NCT02273089 23.10.2014 retrospectively registered.
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Affiliation(s)
- Maria Alexandra Mineiro
- Pulmonology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. .,NOVA Medical School / Faculdade de Ciências Médicas, Lisbon, Portugal.
| | - Pedro Marques da Silva
- Arterial Investigation Unit, Internal Medicine Department IV, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Marta Alves
- Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ana Luísa Papoila
- Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,NOVA Medical School / Faculdade de Ciências Médicas, Lisbon, Portugal
| | | | - João Cardoso
- Pulmonology Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,NOVA Medical School / Faculdade de Ciências Médicas, Lisbon, Portugal
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