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Kamgo T, Spalgais S, Ravishankar N, Kumar R. Role of sleep questionnaires in predicting obstructive sleep apnea amongst interstitial lung diseases patients. Lung India 2023; 40:327-332. [PMID: 37417085 PMCID: PMC10401977 DOI: 10.4103/lungindia.lungindia_731_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 12/27/2022] [Accepted: 01/27/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction The co-existence of obstructive sleep apnea (OSA) and interstitial lung diseases (ILD) results in significant morbidity and mortality. So screening for OSA is important for its early diagnosis among ILD patients. The commonly used questionnaires for screening of OSA are Epworth sleep score (ESS) and STOP-BANG. However, the validity of these questionnaires among ILD patients is not well studied. The aim of this study was to assess the utility of these sleep questionnaires in detection of OSA among ILD patients. Methods It was a prospective observational study of one year in a tertiary chest centre in India. We enrolled 41 stable cases of ILD who were subjected to self-reported questionnaires (ESS, STOP-BANG, and Berlin questionnaire). The diagnosis of OSA was done by Level 1 polysomnography. The correlation analysis was done between the sleep questionnaires and AHI. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all the questionnaires. The cutoff values of STOPBANG and ESS questionnaire were calculated from the ROC analyses. P value of <0.05 was considered to be significant. Results OSA was diagnosed in 32 (78%) patients with mean AHI of 21.8 ± 17.6.The mean age was 54.8 ± 8.9 years with majority being female (78%) and mean body mass index (BMI) was 29.7 ± 6.4 kg/m2. The mean ESS and STOPBANG score were 9.2 ± 5.4 and 4.3 ± 1.8, respectively, and 41% patients showed high risk for OSA with Berlin questionnaire. The sensitivity for detection of OSA was highest (96.1%) with ESS and lowest with Berlin questionnaire (40.6%). The receiver operating characteristics (ROC) area under curve for ESS was 0.929 with optimum cutoff point of 4, sensitivity of 96.9%, and specificity of 55.6%, while ROC area under curve for STOPBANG was 0.918 with optimum cutoff point of 3, sensitivity of 81.2% and specificity of 88.9%.The combination of two questionnaires showed sensitivity of >90%. The sensitivity also increased with the increasing severity of OSA. AHI showed positive correlation with ESS (r = 0.618, P < 0.001) and STOPBANG (r = 0.770, P < 0.001). Conclusion The ESS and STOPBANG showed high sensitivity with positive correlation for prediction of OSA in ILD patients. These questionnaires can be used to prioritize the patients for polysomnography (PSG) among ILD patients with suspicion of OSA.
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Affiliation(s)
- Tome Kamgo
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, Delhi, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, Delhi, India
| | - N Ravishankar
- Department of Biostatics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, Delhi, India
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Silva DVE, Alves DDSB, Nóbrega MDRR, Ribeiro FBCG, Franco LYY, Silva IRD, Joffily L, Rocha MD, Godoy PH. Obstructive sleep apnea screening in different age groups: performance of the Berlin, STOP-Bang questionnaires and Epworth Sleepiness Scale. Braz J Otorhinolaryngol 2023; 89:101283. [PMID: 37418853 PMCID: PMC10345254 DOI: 10.1016/j.bjorl.2023.101283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVE To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. METHODS Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders-third edition. Performance was assessed using 2×2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. RESULTS We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. CONCLUSION In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. LEVEL OF EVIDENCE ACCORDING THE GUIDE FOR AUTHORS: level 2.
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Affiliation(s)
- Daniel Villela E Silva
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Laboratório do Sono da Universidade Federal do Estado de Rio de Janeiro (LABSONO-UNIRIO), Rio de Janeiro, RJ, Brazil.
| | | | | | | | | | | | - Lucia Joffily
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Laboratório do Sono da Universidade Federal do Estado de Rio de Janeiro (LABSONO-UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Maira da Rocha
- Laboratório do Sono da Universidade Federal do Estado de Rio de Janeiro (LABSONO-UNIRIO), Rio de Janeiro, RJ, Brazil; Hospital Universitário Gaffrée e Guinle (HUGG), Empresa Brasileira de Serviços Hospitalares (EBSERH), Rio de Janeiro, RJ, Brazil
| | - Paulo Henrique Godoy
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Laboratório do Sono da Universidade Federal do Estado de Rio de Janeiro (LABSONO-UNIRIO), Rio de Janeiro, RJ, Brazil
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Jang YS, Nerobkova N, Hurh K, Park EC, Shin J. Association between smoking and obstructive sleep apnea based on the STOP-Bang index. Sci Rep 2023; 13:9085. [PMID: 37277416 DOI: 10.1038/s41598-023-34956-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 05/10/2023] [Indexed: 06/07/2023] Open
Abstract
Smoking is a risk factor for respiratory diseases, and it worsens sleep quality due to nicotine stimulation and sudden nicotine withdrawal during sleep. This can increase the severity of OSA through alterations upper airway inflammation and neuromuscular function, arousal mechanisms, and sleep architecture. Therefore, it may lead to sleep-disrupted breathing, particularly obstructive sleep apnea (OSA). Herein, this study aims to research the association between smoking and OSA through the STOP-Bang index. In this study, total sample of 3442 participants (1465 men and 1977 women) were analyzed. We used data from the Korea National Health and Nutrition Examination Survey in 2020 by classifying adults into current, ex-, and non-smokers. A multiple logistic regression analysis was used to investigate the association between smoking and OSA. Furthermore, multinomial regression analysis was used to investigate the effect of smoking cessation. For males, compared to the non-smokers, the odds ratios (OR) for the OSA were significantly higher in the ex-smokers (OR: 1.53, 95% confidence interval(CI) 1.01-2.32) and current smokers (OR: 1.79, 95% CI 1.10-2.89). In females, higher ORs were observed for OSA risk, similar to the non-smokers, smoking cessation, and pack-years. Among men, OSA was significantly associated with a moderate risk for ex-smokers (OR: 1.61, 95% CI 1.05-2.48) and a severe risk for current smokers (OR: 1.88, 95% CI 1.07-3.29). This study observed that smoking might contribute to OSA risk among adults. Smoking cessation can help to manage sleep quality properly.
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Affiliation(s)
- Yun Seo Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Nataliya Nerobkova
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Kyungduk Hurh
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeyong Shin
- Institute of Health Services Research, Yonsei University, 50 Yonsei-to, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, NY, USA.
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Nair AS, Vaze V, Vaid N. Comparative Study of Subjective and Objective Analysis in Diagnosis of Obstructive Sleep Apnea. Indian J Otolaryngol Head Neck Surg 2023; 75:715-722. [PMID: 37206851 PMCID: PMC10188680 DOI: 10.1007/s12070-022-03264-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/23/2022] [Indexed: 11/15/2022] Open
Abstract
The gold standard for diagnosis of Obstructive sleep apnea (OSA) is an overnight polysomnography (PSG). However, PSG is time consuming, labour intensive and expensive. In our country PSG is not available everywhere. Therefore, a simple and reliable method of identifying patients of OSA is important for its prompt diagnosis and treatment. This study looks at the efficacy of three questionnaires to serve as a screening test for the diagnosis of OSA in the Indian population. For the first time in India, a prospective study was conducted wherein patients with history of OSA underwent PSG and were asked to fill three questionnaires-Epworth Sleepiness Score (ESS), Berlin Questionnaire (BQ) and Stop Bang Questionnaire (SBQ). The scoring of these questionnaires were compared with the PSG results. SBQ had a high negative predictive value (NPV) and the probability of moderate and severe OSA steadily increases with higher SBQ scores. In comparison, ESS and BQ had low NPV. SBQ is a useful clinical tool to identify patients at high risk of OSA and can facilitate in the diagnosis of unrecognised OSA.
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Affiliation(s)
- Aathira S. Nair
- ENT Department, KEM Hospital, Pune, Maharashtra India
- Navi Mumbai, India
| | - Varada Vaze
- ENT Department, KEM Hospital, Pune, Maharashtra India
| | - Neelam Vaid
- ENT Department, KEM Hospital, Pune, Maharashtra India
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Lee DW, Lee J. The association between long working hours and obstructive sleep apnea assessed by STOP-BANG score: a cross-sectional study. Int Arch Occup Environ Health 2023; 96:191-200. [PMID: 36008500 DOI: 10.1007/s00420-022-01914-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/10/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE The relationship between night-shift work and obstructive sleep apnea (OSA) is well known, but that between OSA and long working hours is still unknown. This study explores the association between long working hours and OSA. METHODS Using cross-sectional Korean National Health and Nutrition Examination Survey 2020 data, we made multiple logistic regression models to calculate odds ratios (ORs) between weekly working hours and STOP-BANG scores for OSA screening. Stratified regression models by night or rotating shift work were also made. RESULTS In an adjusted model of STOP-BANG high-risk versus low-risk groups, the OR in the group exceeding 40 h/wk was higher but not statistically significant, 1.19 [95% confidence interval (CI) 0.66-2.15] compared to the group working 40 h/wk (standard working hours) or less. In the group exceeding 52 h/wk, the OR was 2.03 with statistical significance (95% CI 1.08-3.80). In the stratification analysis of daytime and night-shift work, the daytime worker results were similar to those in the non-stratified model. The point estimation values of ORs in the night-shift workers were higher than in the daytime workers; however, we did not observe a statistical significance. CONCLUSION Long working hours can increase the risk of OSA assessed by STOP-BANG scores.
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Affiliation(s)
- Dong-Wook Lee
- Public Healthcare Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jongin Lee
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Kang JH, Lee JK. Does risk of obstructive sleep apnea have interaction with chronic facial pain? J Korean Assoc Oral Maxillofac Surg 2022; 48:277-283. [PMID: 36316185 PMCID: PMC9639246 DOI: 10.5125/jkaoms.2022.48.5.277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023] Open
Abstract
Objectives The main purpose of the present study was to investigate the associations between the risk of obstructive sleep apnea (OSA) and chronic orofacial pain in a nationally representative sample of the Korean population. Materials and Methods Data from the 8th wave Korean national health and nutrition examination survey, which was conducted from 2019 to 2020 were analyzed. This study included 5,780 Koreans (2,503 males, 3,277 females) over 40 years of age. The presence of subjective chronic facial pain lasting more than 3 months was evaluated based on a self-reported questionnaire. The risk of OSA was determined using the STOP-BANG questionnaire. Data related to anthropometric and sociodemographic factors; diagnostic history of hypertension, depression, and OSA; level of health-related quality of life and stress awareness; health-related behaviors, including smoking and alcohol drinking; and sleep duration were collected. The participants were classified into two groups according to the presence of chronic facial pain. Results The level of health-related quality of life and stress awareness showed significant differences between the two groups. The sleep duration on weekends also presented significant differences. No significant differences were observed in the presence of snoring and observed apnea, while participants with chronic facial pain showed significantly higher levels of tiredness between the groups. The risk of OSA evaluated by STOP-BANG questionnaire showed significant differences between groups; however, the risk of OSA seemed to be higher in participants without chronic facial pain. Conclusion The participants with chronic facial pain demonstrated decreased sleep duration, lower health-related quality of life, and increased stress and tiredness. Even though, the role of OSA in the development of chronic facial pain was inconclusive from the study, it is possible that ethnicity play a role in relationship between OSA and chronic facial pain.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea
| | - Jeong Keun Lee
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea
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Cho S, Park WJ, Ahn JS, Lim DY, Kim SH, Moon JD. Obstructive sleep apnea risk and hearing impairment among occupational noise-exposed male workers. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2022; 78:108-117. [PMID: 35833486 DOI: 10.1080/19338244.2022.2094306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study aimed to investigate the association between obstructive sleep apnea (OSA) risk and hearing impairment among workers exposed to occupational noise. A cross-sectional study was conducted among 607 healthy male workers at a tire-manufacturing factory. The subjects underwent audiometric testing, and their OSA risk was examined based on the STOP-Bang questionnaire. Hearing impairment was defined as a hearing threshold >25 dB hearing level (HL) in any frequency of 1, 2, 3 and 4 kHz in either ear. High OSA risk was defined as a STOP-bang score of ≥3. Hearing thresholds at 1, 2, 3 and 4 kHz in both ears were significantly higher among workers with high OSA risk than among those with low OSA risk after adjusting for confounders. Multiple logistic regression analysis examining the association of OSA risk and STOP-Bang score with hearing impairment revealed an odds ratio of 1.738 (95% confidence interval [CI] 1.113-2.713, p = 0.015) and 1.256 (95% CI 1.031-1.529, p = 0.023), respectively, after adjusting for confounders. In addition, when the hearing impairment was reclassified into high- and low-frequency hearing impairment, a statistically significant OR was seen for high-frequency hearing impairment. In conclusion, high OSA risk was associated with hearing impairment in occupational noise-exposed workers, especially in the high-frequency range of 3 and 4 kHz. More efforts are required to improve the management of OSA and its risk factors to preserve hearing in occupational noise-exposed workers.
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Affiliation(s)
- Seunghyeon Cho
- Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Won-Ju Park
- Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Ji-Sung Ahn
- Department of Occupational and Environmental Medicine, Mokpo Hankook Hospital, Mokpo, Republic of Korea
| | - Dae-Young Lim
- Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Su-Hwan Kim
- Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Jai-Dong Moon
- Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
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Cerritelli L, Caranti A, Migliorelli A, Bianchi G, Stringa LM, Bonsembiante A, Cammaroto G, Pelucchi S, Vicini C. Sleep position and obstructive sleep apnea (OSA): Do we know how we sleep? A new explorative sleeping questionnaire. Sleep Breath 2022; 26:1973-1981. [DOI: 10.1007/s11325-022-02576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/27/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
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Timofticiuc DP, Vladu I, Stefan A, Forțofoiu M, Mitrea A, Fortofoiu M, Mota M. STOP-BANG QUESTIONNAIRE - AN EASY TOOL FOR IDENTIFYING OBSTRUCTIVE SLEEP APNEA SYNDROME IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2022; 18:49-57. [PMID: 35975264 PMCID: PMC9365405 DOI: 10.4183/aeb.2022.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) have a higher risk of developing obstructive sleep apnea (OSA) compared to the general population. Our study aims to analyze the usefulness of the STOP-BANG score, tool which was not yet validated in patients with diabetets, as a tool that estimates the severity of OSA, in patients with T2DM. METHODS 120 patients, who answered the STOP-BANG questionnaire and underwent polysomnography, were included in the study. The patients were divided into 3 groups, depending on the severity of OSA, defined by the apnea/hypopnea index (AHI). RESULTS A significant percentage of participants (42.1%) had a severe form of OSA (AHI ≥30) and a high percentage of subjects had a STOP-BANG score ≥5 (58.7%), equivalent to a severe form of the disease. The STOP-BANG score increased proportionally with AHI (p<0.001). The area under the ROC curve for the STOP-Bang score indicated an optimal cut-off value of 4.5, with a sensitivity of 88.2% and a specificity of 62.9% (p <0.001), STOP-BANG score ≥5 being an independent predictor for severe OSA in patients with T2DM. CONCLUSIONS The STOP-BANG score can be used in patients with diabetes to detect severe OSA in order to establish appropriate therapeutic measures.
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Affiliation(s)
- D.C. Protasiewicz Timofticiuc
- University of Medicine and Pharmacy of Craiova, Doctoral School, Craiova, Romania
- County Clinical Emergency Hospital of Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, Craiova, Romania
| | - I.M. Vladu
- County Clinical Emergency Hospital of Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, Craiova, Romania
- University of Medicine and Pharmacy of Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, Craiova, Craiova, Romania
| | - A.G. Stefan
- Calafat Municipal Hospital, Calafat, Craiova, Romania
| | - M.C. Forțofoiu
- University of Medicine and Pharmacy of Craiova, Faculty of Medicine, Department of Medical Semiology, Craiova, Romania
- Clinical Municipal Hospital “Philanthropy” of Craiova, Department of Internal Medicine, Craiova, Romania
| | - A. Mitrea
- University of Medicine and Pharmacy of Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, Craiova, Craiova, Romania
- Clinical Municipal Hospital “Philanthropy” of Craiova, Department of Diabetes, Nutrition and Metabolic Diseases, Craiova, Romania
| | - M. Fortofoiu
- University of Medicine and Pharmacy of Craiova, Faculty of Medicine, Department of Emergency Medicine, Craiova, Romania
- Clinical Municipal Hospital “Philanthropy” of Craiova, Department of Emergency, Craiova, Romania
| | - M. Mota
- University of Medicine and Pharmacy of Craiova, Doctoral School, Craiova, Romania
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Kaswan R, Bansal R, Katoch D, Dogra M, Singh R, Gupta V, Dogra MR, Bansal S. Screening for obstructive sleep apnea in a diabetic retinopathy clinic in a tertiary care center. Indian J Ophthalmol 2021; 69:3349-3357. [PMID: 34708803 PMCID: PMC8725143 DOI: 10.4103/ijo.ijo_3633_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To screen for obstructive sleep apnea (OSA) in patients presenting to diabetic retinopathy (DR) clinic and to correlate its presence with the severity of DR. Methods: A prospective, cross-sectional study of diabetes mellitus patients in retina clinic of a tertiary care referral center, North India (January 2019–March 2020). All were subjected to STOP-Bang Questionnaire and Epworth Sleepiness Scale (ESS) score. Patients at high OSA risk (STOP-Bang score ≥5 and ESS score ≥10) were referred to Department of Otorhinolaryngology (sleep clinic) for polysomnography. Based on Apnea Hypopnea Index (AHI), OSA was graded as mild (AHI = 5–14/h), moderate (AHI = 15–30/h), and severe (AHI >30/h). Statistical analysis was done using three models of outcome measures: (1) “No DR” versus “any DR,” (2) “Less severe DR” versus “More severe DR,” and (3) “No diabetic macular edema (DME)” versus “DME.” Results: Of 362 patients screened, 18 (4.97%) had OSA (11 mild, 5 moderate, and 2 severe). Though OSA did not show a significant association with various outcome measures, patients with moderate–severe OSA had higher odds in developing “any DR” (OR = 7.408; 95% CI = 0.533–102.898), “more severe DR” (OR = 1.961; 95% CI = 0.153–25.215), and “DME” (OR = 2.263; 95% CI = 0.357–14.355), on multiple logistic regression. Conclusion: Ours is the first screening study of OSA in DR patients in India, the diabetes capital of the world. We detected OSA in 4.97% of patients in a DR clinic, with an increased risk of “any DR,” “more severe DR,” and “DME” in the presence of moderate–severe OSA.
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Affiliation(s)
- Rakesh Kaswan
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat R Dogra
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Bansal
- Department of Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Butt AM, Syed U, Arshad A. Predictive Value of Clinical and Questionnaire Based Screening Tools of Obstructive Sleep Apnea in Patients With Type 2 Diabetes Mellitus. Cureus 2021; 13:e18009. [PMID: 34667684 PMCID: PMC8516327 DOI: 10.7759/cureus.18009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a major health problem for people with type 2 diabetes mellitus (DM2) and is associated with poorer glycemic control. Early detection is critical to proper management. In this study, we planned to assess and compare the diagnostic accuracy of various OSA screening tools in patients with DM2. Methods In this cross-sectional study, we consecutively recruited 58 patients with DM2, presenting to the endocrinology department of Services Hospital Lahore between February 2020 to March 2021. Along with demographic and anthropometric measurements, including BMI and neck circumference, participants answered the snoring, tiredness, observed apnea, high blood pressure - BMI, age, neck circumference, and gender (STOP-BANG) questionnaire, Berlin questionnaire, and Epworth sleepiness scale. All participants then underwent an overnight, level 3 polysomnography. Results The overall prevalence of OSA, diagnosed by overnight polysomnography, was 65.5% in type 2 diabeticDM2 patients. The STOP-BANG questionnaire had the highest sensitivity for mild, moderate, and severe OSA i.e., 84.2%, 90.3%, and 100% respectively. Berlin questionnaire also had 100% sensitivity for severe OSA and was most specific for mild and moderate OSA (70% and 63% respectively) whereas the Epworth sleepiness scale had the highest specificity of 53.3% for severe OSA. Conclusion This study shows that OSA is highly prevalent in DM2 patients in Pakistan. The STOP-BANG and Berlin questionnaire proved to be effective screening tools, especially for severe OSA. Results of our study should encourage the routine use of these questionnaires in clinical practice, to help in the early identification of OSA in diabetics.
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Affiliation(s)
| | - Uneeba Syed
- Department of Endocrinology and Metabolism, Services Hospital, Lahore, PAK
| | - Adeel Arshad
- Department of Endocrinology and Metabolism, Services Hospital, Lahore, PAK
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Diagnostic accuracy of screening questionnaires for obstructive sleep apnoea in adults in different clinical cohorts: a systematic review and meta-analysis. Sleep Breath 2021; 26:1053-1078. [PMID: 34406554 PMCID: PMC8370860 DOI: 10.1007/s11325-021-02450-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/02/2021] [Accepted: 07/20/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The majority of individuals with clinically significant obstructive sleep apnoea (OSA) are undiagnosed and untreated. A simple screening tool may support risk stratification, identification, and appropriate management of at-risk patients. Therefore, this systematic review and meta-analysis evaluated and compared the accuracy and clinical utility of existing screening questionnaires for identifying OSA in different clinical cohorts. METHODS We conducted a systematic review and meta-analysis of observational studies assessing the diagnostic value of OSA screening questionnaires. We identified prospective studies, validated against polysomnography, and published to December 2020 from online databases. To pool the results, we used random effects bivariate binomial meta-analysis. RESULTS We included 38 studies across three clinical cohorts in the meta-analysis. In the sleep clinic cohort, the Berlin questionnaire's pooled sensitivity for apnoea-hypopnoea index (AHI) ≥ 5, ≥ 15, and ≥ 30 was 85%, 84%, and 89%, and pooled specificity was 43%, 30%, and 33%, respectively. The STOP questionnaire's pooled sensitivity for AHI ≥ 5, ≥ 15, and ≥ 30 was 90%, 90%, and 95%, and pooled specificity was 31%, 29%, and 21%. The pooled sensitivity of the STOP-Bang questionnaire for AHI ≥ 5, ≥ 15, and ≥ 30 was 92%, 95%, and 96%, and pooled specificity was 35%, 27%, and 28%. In the surgical cohort (AHI ≥ 15), the Berlin and STOP-Bang questionnaires' pooled sensitivity were 76% and 90% and pooled specificity 47% and 27%. CONCLUSION Among the identified questionnaires, the STOP-Bang questionnaire had the highest sensitivity to detect OSA but lacked specificity. Subgroup analysis considering other at-risk populations was not possible. Our observations are limited by the low certainty level in available data.
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Waseem R, Chan MTV, Wang CY, Seet E, Tam S, Loo SY, Lam CKM, Hui DS, Chung F. Diagnostic performance of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea in different ethnic groups. J Clin Sleep Med 2021; 17:521-532. [PMID: 33112227 DOI: 10.5664/jcsm.8940] [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 The STOP-Bang questionnaire is a concise and easy screening tool for obstructive sleep apnea (OSA). Using modified body mass index (BMI), we assessed the diagnostic performance of the STOP-Bang questionnaire in predicting OSA in ethnically different groups of patients undergoing surgery. METHODS This was a multicenter prospective cohort study involving patients with cardiovascular risk factors who were undergoing major noncardiac surgery. Patients underwent home sleep apnea testing. All patients completed the STOP-Bang questionnaire. The predictive parameters of STOP-Bang scores were calculated against the apnea-hypopnea index. RESULTS From 4 ethnic groups 1,205 patients (666 Chinese, 161 Indian, 195 Malay, and 183 Caucasian) were included in the study. The mean BMI ranged from 25 ± 4 to 30 ± 6 kg/m² and mean age ranged from 64 ± 8 to 71 ± 10 years. For the Chinese and Indian patients, diagnostic parameters are presented using BMI threshold of 27.5 kg/m² with the area under curve to predict moderate-to-severe OSA being 0.709 (0.665-0.753) and 0.722 (0.635-0.808), respectively. For the Malay and Caucasian, diagnostic parameters are presented using BMI threshold of 35 kg/m² with the area under curve for predicting moderate-to-severe OSA being 0.645 (0.572-0.720) and 0.657 (0.578-0.736), respectively. Balancing the sensitivity and specificity, the optimal STOP-Bang thresholds for the Chinese, Indian, Malay, and Caucasian groups were determined to be 4 or greater. CONCLUSIONS For predicting moderate-to-severe OSA, we recommend BMI threshold of 27.5 kg/m² for Chinese and Indian patients and 35 kg/m² for Malay and Caucasian patients. The optimal STOP-Bang threshold for the Chinese, Indian, Malay and Caucasian groups is 4 or greater. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Postoperative Vascular Events in Unrecognized Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/study/NCT01494181; Identifier: NCT01494181.
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Affiliation(s)
- Rida Waseem
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Matthew T V Chan
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Edwin Seet
- Khoo Teck Puat Hospital, National Healthcare Group, Singapore
| | | | - Su Yin Loo
- Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Carmen K M Lam
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.,Tuen Mun Hospital, Hong Kong Special Administrative Region, China
| | - David S Hui
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Frances Chung
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Neves Junior JAS, Fernandes APA, Tardelli MA, Yamashita AM, Moura SMPGT, Tufik S, Silva HCAD. Cutoff points in STOP-Bang questionnaire for obstructive sleep apnea. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:561-569. [PMID: 33053014 DOI: 10.1590/0004-282x20200086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obstructive Sleep Apnea Syndrome (OSAS) is a public health problem of high prevalence and impacts on quality of life, anesthetic complications and cardiovascular diseases. In view of the difficulty in accessing the polysomnography, it is necessary to validate other methods for OSAS diagnostic screening in clinical practice in our country, such as the STOP-Bang questionnaire. OBJECTIVE To validate the STOP-Bang questionnaire in Brazilians and evaluate optimal cutoff points. METHODS After translation and back-translation, STOP-Bang questionnaire was applied to 71 individuals previously submitted to polysomnography and classified into control, mild, moderate or severe OSAS. RESULTS The majority of patients was male (59.2%), white (79%), aged 48.9±13.9 years, and with neck circumference >40 centimeters (73.8%). STOP-Bang score was higher in OSAS mild (median/inter-quartis 25-75%: 5/3.5-6), moderate (4.5/4-5) and severe (5/4-6), versus control (2.5/1-4). The receiver operating characteristic (ROC) curve indicate that scores 3, 4 and 6, present the best specificity values (100, 80 and 92.9%) with acceptable sensitivity (60, 66.7 and 50%) in the mild, moderate and severe OSAS subgroups, respectively. In OSAS group analysis (Apnea Hypopnea Index [AHI] ≥5, <15, ≥15 - <30, ≥30), STOP-Bang cutoff point of 6 was optimal to detect OSAS. CONCLUSION STOP-Bang Brazilian version identified OSAS patients with lower sensitivity and higher specificity compared to previous studies. Different cutoff points would improve the performance to detect patients with more severe OSAS.
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Affiliation(s)
- Jose Apolinário Silva Neves Junior
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil
| | - Ana Paula Andrade Fernandes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil
| | - Maria Angela Tardelli
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil
| | - Américo Massafuni Yamashita
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil
| | | | - Sérgio Tufik
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Psychobiology, Sleep and Respiratory Divisions, São Paulo SP, Brazil
| | - Helga Cristina Almeida da Silva
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil
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Oktay Arslan B, Uçar Hoşgör ZZ, Orman MN. Which Screening Questionnaire is Best for Predicting Obstructive Sleep Apnea in the Sleep Clinic Population Considering Age, Gender, and Comorbidities? Turk Thorac J 2020; 21:383-389. [PMID: 33352093 DOI: 10.5152/turkthoracj.2019.19024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/17/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the predictive power of the screening questionnaires including Epworth Sleepiness Scale (ESS), Berlin questionnaire (BQ) and STOP-Bang questionnaire (SBQ) to identify the high-risk patients for OSA in a sleep clinic setting considering age, gender and comorbidities. MATERIAL AND METHODS 1003 patients who admitted to our sleep center with the preliminary diagnosis of OSA between June 2016-May 2018 were included in the study. All patients underwent in-lab polysomnographic examination and filled out ESS, Berlin and STOP-Bang questionnaires. Predictive parameters for each screening questionnaires were calculated. RESULTS For apnea-hypopnea index (AHI) ≥5/h, the sensitivity and the specificity of the EES, BQ and SBQ were 50.6%, 89.8%, 97.9% and 56.6%, 27.3%, 16.2% respectively. The STOP-Bang questionnaire had the highest sensitivity in both males and females (99.1%, 94.8% respectively) and in the different age groups (97.3% for ≥45 age-group, 99.2% for ≥65 age-group). In the groups of patients with hypertension, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease and asthma, the sensitivity of the STOP-Bang questionnaire was 99.5%, 100%, 99.5%, 100%, 97.4%, respectively. CONCLUSION The STOP-Bang questionnaire had the highest sensitivity for detecting high-risk patients for OSA in a sleep clinic setting. STOP-Bang questionnaire was superior to the Berlin questionnaire and ESS in the different groups of age, gender, and comorbidities. Considering the close relationship between OSA and comorbidities, it is critical to screen patients in terms of OSA in outpatient clinics of internal medicine, cardiology, and chest disease departments. The STOP-Bang questionnaire, with its high sensitivity, may be useful for screening OSA. However, the low specificity should be improved in the questionnaire.
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Affiliation(s)
- Burcu Oktay Arslan
- Department of Chest Diseases and Sleep Disorders Center University of Healthy Sciences, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, İzmir, Turkey
| | - Zeynep Zeren Uçar Hoşgör
- Department of Chest Diseases and Sleep Disorders Center University of Healthy Sciences, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, İzmir, Turkey
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Oshita H, Ito N, Senoo M, Funaishi K, Mitama Y, Okusaki K. The STOP-Bang Test Is Useful for Predicting the Severity of Obstructive Sleep Apnea. JMA J 2020; 3:347-352. [PMID: 33225107 PMCID: PMC7676986 DOI: 10.31662/jmaj.2020-0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/20/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: The STOP-Bang test was used to detect patients at high risk of obstructive sleep apnea (OSA). We evaluated the usefulness of the STOP-Bang test for predicting the severity of OSA in Japanese patients. Methods: We retrospectively evaluated the patients who performed full polysomnography at the Mihara Medical Association Hospital. We evaluated the correlation between the STOP-Bang score and the apnea hypopnea index (AHI) using Spearman's rank correlation analysis. We then used multivariate analyses to examine the independent risk factor for severe OSA (AHI ≥ 30/hr). Results: One hundred seven patients were diagnosed as no (n = 5), mild (n = 17), moderate (n = 30), and severe (n = 55) OSA. The median age was 67 years old (range: 35-84), and 73 of the 107 patients were males. The correlation coefficient between the STOP-Bang score and AHI was 0.701 (P < 0.001). A STOP-Bang score ≥ 5 had sensitivity of 80.0% and specificity of 76.9% for detecting severe OSA. A STOP-Bang score ≥ 5 and BMI ≥ 30 kg/m2 were the independent risk factor for severe OSA. Conclusions: The STOP-Bang score correlates with AHI and is useful for predicting OSA severity. Polysomnography should be performed actively for the patients with high STOP-Bang scores.
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Affiliation(s)
- Hideto Oshita
- Department of Internal Medicine, Mihara Medical Association Hospital, Mihara, Japan
| | - Noriaki Ito
- Department of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Misato Senoo
- Department of Internal Medicine, Mihara Medical Association Hospital, Mihara, Japan
| | - Kunihiko Funaishi
- Department of Internal Medicine, Mihara Medical Association Hospital, Mihara, Japan
| | - Yasuyuki Mitama
- Department of Internal Medicine, Mihara Medical Association Hospital, Mihara, Japan
| | - Ken Okusaki
- Department of Internal Medicine, Mihara Medical Association Hospital, Mihara, Japan
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Cho SMJ, Lee H, Shim JS, Kim HC. Association of Snoring with Prediabetes and Type 2 Diabetes Mellitus: The Cardiovascular and Metabolic Diseases Etiology Research Center Cohort. Diabetes Metab J 2020; 44:687-698. [PMID: 32431103 PMCID: PMC7643599 DOI: 10.4093/dmj.2019.0128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/24/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Evidence suggests that habitual snoring is an independent risk factor for poor glycemic health. We examined the associations between snoring with prediabetes and diabetes in Korean population. METHODS Self-reported snoring characteristics were collected from 3,948 middle-aged adults without prior cardiovascular diseases. Multivariable linear regression assessed the association of snoring intensity, frequency, disruptiveness, and disrupted breathing with fasting glucose and glycosylated hemoglobin (HbA1c) level. Then, multinomial regression evaluated how increasing snoring symptoms are associated with the risk for prediabetes and diabetes, adjusting for socioeconomic and behavioral risk factors of diabetes, obesity, hypertension, and other sleep variables. RESULTS Higher snoring intensity and frequency were positively associated with fasting glucose and HbA1c levels. Participants presenting the most severe snoring were at 1.84 times higher risk (95% confidence interval [CI], 1.09 to 2.29) for prediabetes and 2.24 times higher risk (95% CI, 1.84 to 2.95) for diabetes, compared to non-snorers. Such graded association was also observed amongst the most frequent snorers with higher risk for prediabetes (odds ratio [OR], 1.78; 95% CI, 1.29 to 2.22) and diabetes (OR, 2.03; 95% CI, 1.45 to 2.85). Disruptive snoring (OR, 1.60; 95% CI, 1.12 to 2.28) and near-daily disruptive breathing (OR, 2.18; 95% CI, 1.02 to 4.19) were associated with higher odds for diabetes. Such findings remained robust after additional adjustment for sleep duration, excessive daytime sleepiness, unwakefulness, and sleep-deprived driving. CONCLUSION Snoring is associated with impaired glucose metabolism even in otherwise metabolically healthy adults. Habitual snorers may require lifestyle modifications and pharmacological treatment to improve glycemic profile.
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Affiliation(s)
- So Mi Jemma Cho
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jee-Seon Shim
- Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
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Cho J, Choi SM, Park YS, Lee CH, Lee SM, Yoo CG, Kim YW, Lee J. Prediction of cardiopulmonary events using the STOP-Bang questionnaire in patients undergoing bronchoscopy with moderate sedation. Sci Rep 2020; 10:14471. [PMID: 32879339 PMCID: PMC7468304 DOI: 10.1038/s41598-020-71314-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022] Open
Abstract
The objective was to evaluate the prevalence of patients at a high risk of having OSA by using a screening questionnaire and to investigate whether the questionnaire can predict patients who are at risk of cardiopulmonary events occurring during a bronchoscopy under sedation. We prospectively enrolled consecutive adult patients who underwent flexible bronchoscopies under moderate sedation. The snoring, tiredness, observed apnea, high blood pressure-body mass index, age, neck circumference and gender (STOP-Bang) questionnaire was used to identify patients at a high (score ≥ 3 of 8) or low risk (score < 3 of 8) of having OSA. The cardiopulmonary events included hypoxemia and hypotension. Multivariable logistic regression was performed with variables selected by the least absolute shrinkage and selection operator. The prevalence of a STOP-Bang score of ≥ 3 was 67.2% (195/290), and 36.9% (107/290) experienced cardiopulmonary events. The multivariable analysis adjusting for chronic obstructive pulmonary disease, chronic kidney disease, baseline SpO2, and procedure time revealed that a STOP-Bang score of ≥ 3 was significantly associated with cardiopulmonary events in a subgroup of patients without a history of cerebrovascular disease (adjusted odds ratio, 1.94; 95% confidence interval, 1.06-3.54). The STOP-Bang questionnaire can predict cardiopulmonary events occurring during this procedure.Trial registration: NCT03325153.
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Affiliation(s)
- Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, 03080, Republic of Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, 03080, Republic of Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, 03080, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, 03080, Republic of Korea.
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Byun JI, Kim DH, Kim JS, Shin WC. Usefulness of Using Alternative Body-Mass Index and Neck Circumference Criteria for STOP-Bang Questionnaire in Screening South Korean Obstructive Sleep Apnea Patients. SLEEP MEDICINE RESEARCH 2020. [DOI: 10.17241/smr.2020.00591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Validity of the STOP-Bang Questionnaire in Identifying OSA in a Dental Patient Cohort. ACTA ACUST UNITED AC 2020; 56:medicina56070324. [PMID: 32629852 PMCID: PMC7404476 DOI: 10.3390/medicina56070324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 12/01/2022]
Abstract
Background and objectives: Obstructive Sleep Apnea represents a widespread problem in the population, but it is often not diagnosed and not considered a true pathology. Different diagnostic tools are available for the diagnosis of sleep apnea. This study aims to demonstrate the ability of the STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) questionnaire in identifying subjects with Obstructive Sleep Apnea (OSA) Syndrome, highlighting the role of dentists as epidemiological sentinels. Materials and methods: the STOP-Bang questionnaire was administered to a cohort of 1000 patients, assessing three private dental clinics in Italy. Excessive daytime sleepiness was measured using Epworth Sleepiness Scale (ESS) and defined as ≥ 10. Subjects were considered at risk of OSA if they had three or more positive items at STOP-Bang and were invited to undergo further examination with a type 3 polygraph. Presence of OSA was measured with the apnea-hypopnea index (AHI) and defined as AHI ≥ 5. Results: 482/1000 subjects (48.2%) had three or more positive items in the STOP-Bang questionnaire and were considered at risk for Obstructive Sleep Apnea Syndrome (OSAS). Excessive daytime sleepiness (EDS ≥ 10) was more frequent among subjects at risk for OSAS (73/482, 15.1%) vs. those not at risk for OSAS (30/518, 5.8%) (p < 0.0001). Moreover, 153/482 subjects at risk for OSAS (31.7%) accepted further examination with a type 3 polygraph. Presence of OSAS (AHI ≥ 5) was suggested in 121/153 subjects (79.1%, 95% CI 71.6% to 85.1%), with 76/121 subjects (62.8%) needing treatment (AHI ≥ 15). Conclusion: the high prevalence of OSAS highlights the role of dentists as “epidemiological sentinels”. The STOP-Bang questionnaire is a simple and efficacious instrument for screening sleep apnea patients.
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Awareness of obstructive sleep apnea among critical care physicians in Sharkia Governorate, Egypt. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients with symptoms of obstructive sleep apnea (OSA) present to nearly all physicians irrespective of their specialties. A basic knowledge of OSA is considered essential to identify those patients for appropriate referral and treatment. This study aimed to assess the knowledge and attitude of Sharkia Governorate Critical Care physicians regarding OSA using a standard validated questionnaire.
Results
This cross-sectional survey study was performed on a sample of Sharkia Governorate physicians, from all critical care units in tertiary and secondary hospitals including the following specialties: chest, internal medicine, neurology, cardiology, pediatric, and anesthesia. The OSA knowledge and attitudes (OSAKA) questionnaire that consists of 18 knowledge assessment questions and the OSA attitude questionnaire that consists of 6 attitude assessment questions were used. A total of 231, out of 296 invited physicians, completed the given questionnaire with a response rate of 78%. The mean score for knowledge assessment was 10.05 ± 2.3 with a 33.3% adequate response, while the mean score for attitude assessment was 3.75 ± 1.22 with a 59.3% adequate response. The mean OSA knowledge (12.5 ± 2.42) and attitude (5 ± 0.78) scores were highest among chest physicians when compared to physicians from other specialties (p < 0.001). A significant positive correlation between knowledge and attitude scores was found among Sharkia Governorate critical care physicians (r = 0.55, p < 0.001).
Conclusions
The level of knowledge of OSA among Sharkia Governorate critical care physicians was far from optimal whereas the attitude regarding OSA was acceptable.
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Validation of the NoSAS Score for the Screening of Sleep-Disordered Breathing in a Sleep Clinic. Can Respir J 2020; 2020:4936423. [PMID: 31998424 PMCID: PMC6977329 DOI: 10.1155/2020/4936423] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background There is a growing number of patients with sleep-disordered breathing (SDB) referred to sleep clinics. Therefore, a simple but useful screening tool is urgent. The NoSAS score, containing only five items, has been developed and validated in population-based studies. Aim To evaluate the performance of the NoSAS score for the screening of SDB patients from a sleep clinic in China, and to compare the predictive value of the NoSAS score with the STOP-Bang questionnaire. Methods We enrolled consecutive patients from a sleep clinic who had undergone apnea-hypopnea index (AHI) testing by type III portable monitor device at the hospital and completed the STOP-Bang questionnaire. The NoSAS score was assessed by reviewing medical records. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) of both screening tools were calculated at different AHI cutoffs to compare the performance of SDB screening. Results Of the 596 eligible patients (397 males and 199 female), 514 were diagnosed with SDB. When predicting overall (AHI ≥ 5), moderate-to-severe (AHI ≥ 15), and severe (AHI ≥ 30) SDB, the sensitivity and specificity of the NoSAS score were 71.2, 80.4, and 83.1% and 62.4, 49.3, and 40.7%, respectively. At all AHI cutoffs, the AUC ranged from 0.688 to 0.715 for the NoSAS score and from 0.663 to 0.693 for the STOP-Bang questionnaire. The NoSAS score had the largest AUC (0.715, 95% CI: 0.655–0.775) of diagnosing SDB at AHI cutoff of ≥5 events/h. NoSAS performed better in discriminating moderate-to-severe SDB than STOP-Bang with a marginally significantly higher AUC (0.697 vs. 0.663, P=0.046). Conclusion The NoSAS score had good performance on the discrimination of SDB patients in sleep clinic and can be utilized as an effective screening tool in clinical practice.
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Alshaer H, Hummel R, Mendelson M, Marshal T, Bradley TD. Objective Relationship Between Sleep Apnea and Frequency of Snoring Assessed by Machine Learning. J Clin Sleep Med 2019; 15:463-470. [PMID: 30853041 PMCID: PMC6411174 DOI: 10.5664/jcsm.7676] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/31/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVES Snoring is perceived to be directly proportional to sleep apnea severity, especially obstructive sleep apnea (OSA), but this notion has not been thoroughly and objectively evaluated, despite its popularity in clinical practice. This might lead to overdiagnosis or underdiagnosis of OSA. The goal of this study is to examine this notion and objectively quantify the relationship between sleep apnea and snoring detected using advanced signal processing algorithms. METHODS We studied adults referred for polysomnography, from which the apnea-hypopnea index (AHI) was derived. Breath sounds were recorded simultaneously, from which snoring was accurately quantified using acoustic analysis of breath sounds and machine-learning computer algorithms. The snore index (SI) was calculated as the number of snores per hour of sleep. RESULTS In 235 patients, the mean AHI was 20.2 ± 18.8 and mean SI was 320.2 ± 266.7 events/h. On the one hand, the overall correlation between SI and AHI was weak but significant (r = .32, P < .0001). There was a significant stepwise increase in SI with increasing OSA severity, but with a remarkable overlap in SI among OSA severity categories. On the other hand, SI had weak negative correlation with central AHI (r = -.14, P = .035). SI had modest positive and negative predictive values for OSA (0.63 and 0.62 on average, respectively) and good sensitivity but low specificity (0.91 and 0.31 on average, respectively) attributed to the large number of snorers without OSA. CONCLUSIONS Snoring on its own is probably of limited usefulness in assessing sleep apnea presence and severity, because of its weak relationship with AHI. Thus, the complaint of snoring should be interpreted with caution to avoid unnecessary referrals for sleep apnea testing. Conversely, clinicians should be aware of the possibility of missing diagnosis of patients with sleep apnea who have minimal snoring.
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Affiliation(s)
- Hisham Alshaer
- Sleep Research Laboratory and Home and Community Team, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Richard Hummel
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Monique Mendelson
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Travis Marshal
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - T. Douglas Bradley
- Sleep Research Laboratories of the Toronto Rehabilitation Institute and Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Centre for Sleep Medicine and Circadian Biology of the University of Toronto, Toronto, Ontario, Canada
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Kim KT, Cho YW. Real-world STOPBANG: how useful is STOPBANG for sleep clinics? Sleep Breath 2019; 23:1219-1226. [PMID: 30877515 DOI: 10.1007/s11325-019-01806-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The STOPBANG questionnaire has been widely used for screening obstructive sleep apnea (OSA) due to its time friendly, economic advantages over overnight polysomnography (PSG). The aim of this study was to analyze the usefulness of the items constituting the utility of STOPBANG in a sleep clinic and to establish the best assembly for OSA-screening methods in the Korean population. METHODS We retrospectively analyzed all patients who completed PSG as well as STOPBANG at a sleep center in a tertiary hospital from January 2016 to December 2017. The sensitivity and specificity of STOPBANG and its smaller counterparts (i.e., SOPBAG) were compared. RESULTS A total of 541 subjects completed PSG and STOPBANG. Two hundred thirty-five patients were diagnosed with OSA (OSA+) and were compared to those who were not (OSA-). The respective scores of STOPBANG in OSA+ versus OSA- were 4.29 ± 1.46 and 2.53 ± 1.48 (p < 0.001). There were significant differences in all factors except tiredness and age (SOPBNG). STOPBANG showed sensitivity of 89.1% and specificity of 57.4%. The AUC was 0.809. Excluding tiredness as well as neck circumference (SOPBAG), the AUC was 0.811. The sensitivity and specificity were 71.8% and 77.9%, respectively. The AUC of SOPBAG was neither superior nor inferior to that of STOPBANG. CONCLUSION The screening value of STOPBANG for OSA did not perform as expected when compared to PSG for accuracy in Koreans. STOPBANG can be simplified to SOPBAG while maintaining comparable screening performance. It may be practical to consider performing PSGs without the use of the STOPBANG in Korea.
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Affiliation(s)
- Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea.
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Lee SA, No YJ, Jo KD, Kwon JH, Kim JY, Shin DJ. Factors contributing to excessive daytime sleepiness in Korean adults with epilepsy: A sleep questionnaire-based study. Epilepsy Behav 2019; 90:61-65. [PMID: 30513436 DOI: 10.1016/j.yebeh.2018.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/04/2018] [Accepted: 11/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We determined factors contributing to excessive daytime sleepiness (EDS) in Korean adults with epilepsy (AWE). METHODS A total of 147 AWE who had been treated for >1 year were included. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Subjective sleep disturbances were assessed with the Sleep Apnea of Sleep Disorder Questionnaire (SA-SDQ) and questionnaires about insomnia and restless legs syndrome (RLS). The Hospital Anxiety and Depression Scale (HADS) was also used. An ESS score >10 was considered indicative of EDS. Multivariate logistic regression analyses using the backward elimination method were performed for variables with a p < 0.10 on univariate analysis. RESULTS The mean ESS score was 6.8 (standard deviation [SD]: 4.4). Among the 147 subjects, 36 (24.5%) had EDS. Multivariate logistic regression analysis showed that being employed (odds ratio [OR]: 4.469, p < 0.01), the presence of at least one sleep disturbance (OR: 3.626, p < 0.01), and antiepileptic drug (AED) polytherapy (OR: 2.663, p < 0.05) were independently associated with EDS in the overall group of AWE. In contrast, being employed (p < 0.05) and higher Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) scores (p < 0.05) in a model for men with epilepsy, as well as having at least one sleep disturbance (p < 0.05) in a model for women with epilepsy, were identified as independent factors for EDS. CONCLUSIONS Excessive daytime sleepiness in AWE may have a multifactorial origin. Being employed, subjective sleep disturbances, and AED polytherapy are independent predictors of EDS. There may be sex differences in factors associated with EDS.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Young-Joo No
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Kwang-Deog Jo
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jeong Yeon Kim
- Department of Neurology, Sanggye Paik Hospital, Inje University, Seoul, Republic of Korea
| | - Dong-Jin Shin
- Department of Neurology, Gil Medical Center, Gachon Medical School, Incheon, Republic of Korea
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Jeon HJ, Bang YR, Yoon IY. A validation study on three screening questionnaires for obstructive sleep apnea in a Korean community sample. Sleep Breath 2018; 23:969-977. [PMID: 30448963 DOI: 10.1007/s11325-018-1748-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is highly prevalent and causes serious cardiovascular complications. Several screening questionnaires for OSA have been introduced, but only few validation studies have been conducted in general population. The aim of the present study was to assess the diagnostic value of three OSA screening questionnaires (Berlin Questionnaire, BQ; STOP-Bang Questionnaire, STOP-B; Four-Variable Screening Tool, Four-V) in a Korean community sample. METHODS A total of 1148 community-dwelling participants completed the BQ, STOP-B, and Four-V. An overnight in-laboratory polysomnography (PSG) was conducted in randomly selected 116 participants. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and area under the curve (AUC) were calculated. RESULTS The Four-V with cutoff ≥ 8 showed high sensitivity for overall OSA (69.4%), and the Four-V with cutoff ≥ 9 showed high specificity for both overall OSA (81.5%) and moderate to severe OSA (69.0%). On the other hand, the STOP-B showed acceptable sensitivity and specificity for both overall OSA (61.3 and 79.6%, respectively) and moderate to severe OSA (72.4 and 67.8%, respectively). The STOP-Bang also showed the largest area under the receiver-operator characteristic curve for both overall OSA (0.752) and moderate to severe OSA (0.750). The BQ showed the lowest performance in predicting OSA. CONCLUSIONS Among the three questionnaires, the STOP-B was revealed as the most useful screening tool for OSA in terms of sensitivity, specificity, and area under the receiver-operator characteristic curve in the population of South Korea.
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Affiliation(s)
- Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, Seoul, South Korea
| | - Young Rong Bang
- Department of Psychiatry, Dong-A University Hospital, Busan, South Korea
| | - In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, 463-707, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea. .,Department of Psychiatry, School of Medicine, Seoul National University, Seoul, South Korea.
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Wagner S, Quente J, Staedtler S, Koch K, Richter-Schmidinger T, Kornhuber J, Ihmsen H, Schuettler J. A high risk of sleep apnea is associated with less postoperative cognitive dysfunction after intravenous anesthesia: results of an observational pilot study. BMC Anesthesiol 2018; 18:139. [PMID: 30285632 PMCID: PMC6169037 DOI: 10.1186/s12871-018-0602-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/24/2018] [Indexed: 11/15/2022] Open
Abstract
Background The obstructive sleep apnea syndrome (OSAS) is characterized by temporary cerebral hypoxia which can cause cognitive dysfunction. On the other hand, hypoxia induced neurocognitive deficits are detectable after general anesthesia. The objective of this study was to evaluate the impact of a high risk of OSAS on the postoperative cognitive dysfunction after intravenous anesthesia. Methods In this single center trial between June 2012 and June 2013 43 patients aged 55 to 80 years with an estimated hospital stay of at least 3 days undergoing surgery were enrolled. Patients were screened for a high risk of OSAS using the STOP-BANG test. The cognitive function was assessed using a neuropsychological test battery, including the DemTect test for cognitive impairment and the RMBT test for memory, the day before surgery and within 36 h after extubation. Results Twenty-two of the 43 analyzed patients were identified as patients with a high risk of OSAS. Preoperatively, OSAS patients showed a significant worse performance only for the DemTect (p = 0.0043). However, when comparing pre- and postoperative test results, the OSAS patients did not show a significant loss in any test but significantly improved in RMBT test, whereas the control group showed a significant worse performance in three of eight tests. In five tests, we found a significant difference between the two groups with respect to the change from pre- to postoperative cognitive function. Conclusion Patients with a high risk of OSAS showed a less impairment of memory function and work memory performance after intravenous anesthesia. This might be explained by a beneficial effect of intrinsic hypoxic preconditioning in these patients.
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Affiliation(s)
- Soeren Wagner
- Department of Anesthesiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany. .,Department of Anesthesiology, Katharinenhospital Klinikum Stuttgart, Kriegsbergstrasse 60, D-70174, Stuttgart, Germany.
| | - Joerg Quente
- Department of Anesthesiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sven Staedtler
- Department of Anesthesiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Katharina Koch
- Department of Anesthesiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, Klinikum Oldenburg AöR, University Hospital Oldenburg, Oldenburg, Germany
| | - Tanja Richter-Schmidinger
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen, Germany
| | - Harald Ihmsen
- Department of Anesthesiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Juergen Schuettler
- Department of Anesthesiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Miller JN, Kupzyk KA, Zimmerman L, Pozehl B, Schulz P, Romberger D, Berger AM. Comparisons of measures used to screen for obstructive sleep apnea in patients referred to a sleep clinic. Sleep Med 2018; 51:15-21. [PMID: 30077956 DOI: 10.1016/j.sleep.2018.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/18/2018] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVES Obstructive Sleep Apnea (OSA) contributes to all-cause mortality. An American Academy of Sleep Medicine task force is focusing on improving detection and categorization of OSA symptoms and severity to promote screening, assessment, and diagnosis. The purpose of this study was to psychometrically compare measures used in OSA screening (Berlin, Epworth Sleepiness Scale (ESS), STOP Bang) and a portable sleep monitor (PSM) to apnea-hypopnea index (AHI) and levels from polysomnogram (PSG). METHODS An observational, cross-sectional design was used. Patients referred to a sleep specialist were enrolled at initial sleep evaluation. Participants completed measures used in OSA screening, then sent home for one night using PSM. PSGs were ordered by the physician and AHI results were obtained from the medical record. RESULTS Participants (N = 170) were enrolled in the study. Almost all participants completed the OSA measures, approximately half-completed PSM measurement, and the majority completed laboratory PSG. The STOP Bang had the highest levels of sensitivity; the ESS had the lowest. The ESS had the highest specificity and reliability levels; the STOP Bang had the lowest. The PSM measure had the highest positive predictive value (PPV) and the strongest psychometric properties of the screening measures. CONCLUSIONS The STOP Bang was the preferred self-report OSA screening measure because of high levels of sensitivity. The ESS was the least desirable measure. PSM measurement consistently predicted the presence of OSA but at the expense of low sensitivity at AHI levels ≥30. This expands the knowledge of validity testing of screening measures used for OSA.
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Affiliation(s)
- Jennifer N Miller
- Nebraska Pulmonary Specialties, LLC, 1500 S. 48th St. #800, Lincoln, NE, 68506, USA.
| | - Kevin A Kupzyk
- The University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, 4111 Dewey Avenue, Omaha, NE, USA
| | - Lani Zimmerman
- The University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, 4111 Dewey Avenue, Omaha, NE, USA
| | - Bunny Pozehl
- The University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, 4111 Dewey Avenue, Omaha, NE, USA
| | - Paula Schulz
- The University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, 4111 Dewey Avenue, Omaha, NE, USA
| | - Debra Romberger
- The University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, 4111 Dewey Avenue, Omaha, NE, USA
| | - Ann M Berger
- The University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, 4111 Dewey Avenue, Omaha, NE, USA
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Amra B, Rahmati B, Soltaninejad F, Feizi A. Screening Questionnaires for Obstructive Sleep Apnea: An Updated Systematic Review. Oman Med J 2018; 33:184-192. [PMID: 29896325 DOI: 10.5001/omj.2018.36] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is associated with significant morbidity. We sought to present an updated systematic review of the literature on the accuracy of screening questionnaires for OSA against polysomnography (PSG) as the reference test. Using the main databases (including Medline, Cochrane Database of Systematic Reviews and Scopus) we used a combination of relevant keywords to filter studies published between January 2010 and April 2017. Population-based studies evaluating the accuracy of screening questionnaires for OSA against PSG were included in the review. Thirty-nine studies comprising 18 068 subjects were included. Four screening questionnaires for OSA had been validated in selected studies including the Berlin questionnaire (BQ), STOP-Bang Questionnaire (SBQ), STOP Questionnaire (SQ), and Epworth Sleepiness Scale (ESS). The sensitivity of SBQ in detecting mild (apnea-hypopnea index (AHI) ≥ 5 events/hour) and severe (AHI ≥ 30 events/hour) OSA was higher compared to other screening questionnaires (range from 81.08% to 97.55% and 69.2% to 98.7%, respectively). However, SQ had the highest sensitivity in predicting moderate OSA (AHI ≥ 15 events/hour; range = 41.3% to 100%). SQ and SBQ are reliable tools for screening OSA among sleep clinic patients. Although further validation studies on the screening abilities of these questionnaires on general populations are required.
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Affiliation(s)
- Babak Amra
- Bamdad Respiratory and Sleep Research Center, Pulmonary Ward, Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Rahmati
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forogh Soltaninejad
- Pulmonary Ward, Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Amra B, Javani M, Soltaninejad F, Penzel T, Fietze I, Schoebel C, Farajzadegan Z. Comparison of Berlin Questionnaire, STOP-Bang, and Epworth Sleepiness Scale for Diagnosing Obstructive Sleep Apnea in Persian Patients. Int J Prev Med 2018; 9:28. [PMID: 29619152 PMCID: PMC5869953 DOI: 10.4103/ijpvm.ijpvm_131_17] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/10/2017] [Indexed: 12/24/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) is a common disorder characterized by snoring, daytime sleepiness, fatigue, and repeated termination of airflow (apnea). Standard polysomnography (PSG) is diagnostic gold standard for OSA. PSG is expensive and not available everywhere. To identify the best OSA questionnaire for screening in Persian population, we compared Berlin, STOP-BANG, and Epworth Sleepiness Scale (ESS). Methods: In a cross-sectional study conducted on 400 adult patients suspected of OSA in Bamdad Respiratory Research Center, patients completed three questionnaires. For each questionnaire, patients were divided into high risk and low risk. Then, PSG was performed for all patients. According to PSG, patients categorized into without OSA (apnea-hypopnea index [AHI] <5), mild OSA (15> AHI ≥5), moderate OSA (30> AHI ≥15), and severe OSA (AHI ≥30). Based on questionnaires and PSG results, predictive parameters for screening tests were calculated. Results: There were 234 (58.5%) males and 166 (41.5%) females in study population. Mean age of patients was 49.29 ± 9.75 standard deviation years. There was significant association between age with OSA (P = 0.005) and between body mass index (BMI) and neck circumference, with moderate and severe OSA (P < 0.001). Sensitivities of Berlin, STOP-BANG, and ESS were 86.42%, 81.46%, and 59%, respectively. Specificities of Berlin, STOP-BANG, and ESS were 52.94%, 82.35%, and 76.47%, respectively. Conclusions: This study suggested that Berlin and STOP-BANG are more sensitive and accurate than ESS for OSA screening in Iran.
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Affiliation(s)
- Babak Amra
- Department of Medicine, Pulmonary Unit, Isfahan University of Medical Sciences, Bamdad Respiratory Research Center, Isfahan, Iran
| | - Maedeh Javani
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forogh Soltaninejad
- Department of Medicine, Pulmonary Unit, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Thomas Penzel
- Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Department of Cardiology and Pulmonology, Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Schoebel
- Department of Cardiology and Angiology, Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ziba Farajzadegan
- Department of Community and Preventive Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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STOP-Bang questionnaire screening for obstructive sleep apnea among Chinese patients with type 2 diabetes mellitus. Arch Med Sci 2018; 14:971-978. [PMID: 30154877 PMCID: PMC6111350 DOI: 10.5114/aoms.2018.73984] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/04/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The aim of the current study was to evaluate the efficiency of the STOP-Bang questionnaire for obstructive sleep apnea (OSA) screening among Chinese patients with type 2 diabetes mellitus (T2DM). Material and methods A total of 262 patients with T2DM were enrolled for STOP-Bang questionnaire evaluation and polysomnography (PSG) monitoring between May 2015 and September 2016. Patients were divided into non-OSA and different OSA severity groups (mild, moderate, and severe) according to the apnea-hypopnea index (AHI). The value of the STOP-Bang questionnaire for OSA screening was evaluated. Results Efficiency of the STOP-Bang questionnaire for OSA screening among Chinese patients with T2DM was as follows: when AHI ≥ 5/h, the area under the curve (AUC) was 0.825 (95% confidence interval (CI): 0.763–0.887, p < 0.05), sensitivity was 85.6% (95% CI: 85.55–85.65%, p < 0.05) and specificity was 60% (95% CI: 59.85–60.15%, p < 0.05); when AHI > 15/h, the AUC was 0.856 (95% CI: 0.799–0.913, p < 0.05), sensitivity was 88.6% (95% CI: 88.55–88.65%, p < 0.05) and specificity was 38.4% (95% CI: 38.30–38.49%, p < 0.05); when AHI > 30/h, the AUC was 0.891 (95% CI: 0.836–0.946, p < 0.05), sensitivity was 90.5% (95% CI: 90.44–90.56%, p < 0.05), and specificity was 27% (95% CI: 26.94-27.07%, p < 0.05). Conclusions The STOP-Bang questionnaire is an effective tool for OSA screening among Chinese patients with T2DM. A cut-off score of 3 distinguishes OSA from non-OSA with high sensitivity.
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Hwang CS, Kim JW, Kim JW, Lee EJ, Kim CH, Yoon JH, Cho HJ. Comparison of robotic and coblation tongue base resection for obstructive sleep apnoea. Clin Otolaryngol 2017; 43:249-255. [PMID: 28800204 DOI: 10.1111/coa.12951] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of transoral robotic surgery (TORS) with endoscope-guided coblation tongue base resection. DESIGN Retrospective case-control study. SETTING University-based tertiary care medical center. PARTICIPANTS Patients with obstructive sleep apnoea (OSA) who underwent endoscope-guided tongue base coblation resection or transoral robotic surgery (TORS) in combination with lateral pharyngoplasty at a single institution in South Korea between April 2013 and December 2016 were investigated. Forty-five patients who had moderate-to-severe OSA with tongue base collapse and a minimum follow-up period of 6 months with postoperative polysomnography (PSG) were enrolled in this study. MAIN OUTCOME MEASURES All patients underwent pre- and postoperative (at least 4 months after surgery) overnight PSG. Available information on results of the PSG, Epworth sleepiness scale and complications of the TORS and coblation groups were compared. RESULTS Postoperative PSG studies showed improved sleep quality for most patients. The mean postoperative apnoea-hypopnea index (AHI) was reduced significantly from 45.0 to 17.0 events/h (P < .0001) in the TORS group and from 45.6 to 16.2 events/h (P < .0001) in the coblation group. The mean rates of improvement (AHI reduction > 50%) were 75.0% in TORS patients and 62.1% in coblation patients and the difference was not significant. Less frequent postoperative morbidity, including bleeding, taste dysfunction and foreign body sensation, was recorded in TORS patients. CONCLUSIONS Both the coblation and TORS groups showed similar surgical outcomes, TORS achieved PSG results non-inferior to and complication rates comparable to coblation.
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Affiliation(s)
- C S Hwang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - J W Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - J W Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - E J Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - C-H Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - J-H Yoon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - H-J Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
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Escobar-Córdoba F, Eslava-Schmalbach J. Evaluación del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) mediante instrumentos de medición como escalas y fórmulas matemáticas. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
La psicometría del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) se puede proporcionar con el uso de variados métodos de evaluación como entrevistas clínicas, escalas, cuestionarios de sueño, autoregistros y registros psicofisiológicos. La prueba de oro para el diagnóstico de esta enfermedad sigue siendo la polisomnografía, la cual puede llegar a tener altos costos y dificultades para acceder al estudio. Debido a la alta morbimortalidad asociada a este síndrome, se requieren instrumentos que permitan la identificación rápida de individuos que puedan estar en riesgo de padecerlo. Por tales motivos, se han desarrollado herramientas que permiten detectar los pacientes en riesgo de presentar SAHOS, tales como el Cuestionario de Berlín, el STOP-Bang y la Escala de Somnolencia de Epworth. Es importante tener en cuenta los alcances y limitaciones de estas herramientas para escoger el instrumento indicado según lo que se desee evaluar.
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Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev 2017; 34:70-81. [PMID: 27568340 DOI: 10.1016/j.smrv.2016.07.002] [Citation(s) in RCA: 1288] [Impact Index Per Article: 184.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/09/2016] [Accepted: 07/10/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Chamara V Senaratna
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - Jennifer L Perret
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia; The Institute for Breathing & Sleep, Heidelberg, Melbourne, Australia.
| | - Caroline J Lodge
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Adrian J Lowe
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Brittany E Campbell
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Melanie C Matheson
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Garun S Hamilton
- Department of Lung and Sleep Medicine, Monash Health, Clayton, Australia; School of Clinical Sciences, Monash University, Clayton, Australia.
| | - Shyamali C Dharmage
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
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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: 1477] [Impact Index Per Article: 211.0] [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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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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Righi CG, Martinez D, Gonçalves SC, Gus M, Moreira LB, Fuchs SC, Fuchs FD. Influence of high risk of obstructive sleep apnea on adherence to antihypertensive treatment in outpatients. J Clin Hypertens (Greenwich) 2017; 19:534-539. [PMID: 28266781 DOI: 10.1111/jch.12992] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/27/2016] [Accepted: 10/29/2016] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea (OSA) is a common cause of high blood pressure (BP). Many patients, however, have uncontrolled BP because of nonadherence to antihypertensive medication. The possibility that OSA influences adherence has not been investigated to date. The authors sought to explore the possible association between high risk of OSA and nonadherence. This study was carried out in a hypertension outpatient clinic. Adherence to medication, high risk of OSA, and sleepiness were evaluated in a cross-sectional study. These variables were identified using the eight-item Morisky, STOP-Bang, and Epworth scales, respectively. A total of 416 patients with hypertension were enrolled (32% male, aged 65±11 years). Nonadherence was identified in 71 (17%) individuals. The prevalence of high risk of OSA was 323 (78%) and of somnolence was 136 (33%). High risk of OSA was associated with nonadherence, showing a prevalence ratio (PR) of 2.6 (95% confidence interval [CI], 1.3-5.6) and retained significance after adjustment for sleepiness (PR, 2.3; 95% CI, 1.1-4.9 [P=.011]). Sleepiness was also associated with nonadherence (PR, 1.7; 95% CI, 1.1-2.6 [P=.003]). High risk of OSA and sleepiness are associated with nonadherence. These conditions, if treated, may allow for achieving better outcomes and improvement of adherence to medication.
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Affiliation(s)
- Camila G Righi
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Denis Martinez
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Cardiology, Hypertension and Sleep Clinics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sandro C Gonçalves
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Cardiology, Hypertension and Sleep Clinics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Miguel Gus
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Cardiology, Hypertension and Sleep Clinics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leila B Moreira
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Cardiology, Hypertension and Sleep Clinics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sandra C Fuchs
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Flavio D Fuchs
- Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Cardiology, Hypertension and Sleep Clinics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, Wang YC, Guilleminault C. Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis. Sleep Med Rev 2016; 36:57-70. [PMID: 27919588 DOI: 10.1016/j.smrv.2016.10.004] [Citation(s) in RCA: 318] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 11/24/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder; however, it remains underdiagnosed and undertreated. Although screening tools such as the Berlin questionnaire (BQ), STOP-BANG questionnaire (SBQ), STOP questionnaire (STOP), and Epworth sleepiness scale (ESS) are widely used for OSA, the findings regarding their diagnostic accuracy are controversial. Therefore, this meta-analysis investigated and compared the summary sensitivity, specificity, and diagnostic odds ratio (DOR) among the BQ, SBQ, STOP, and ESS according to the severity of OSA. Electronic databases, namely the Embase, PubMed, PsycINFO, ProQuest dissertations and theses A&I databases, and China knowledge resource integrated database, were searched from their inception to July 15, 2016. We included studies examining the sensitivity and specificity of the BQ, SBQ, STOP, and ESS against the apnea-hypopnea index (AHI) or respiratory disturbance index (RDI). The revised quality assessment of diagnostic accuracy studies was used to evaluate the methodological quality of studies. A random-effects bivariate model was used to estimate the summary sensitivity, specificity, and DOR of the tools. We identified 108 studies including a total of 47 989 participants. The summary estimates were calculated for the BQ, SBQ, STOP, and ESS in detecting mild (AHI/RDI ≥ 5 events/h), moderate (AHI/RDI ≥ 15 events/h), and severe OSA (AHI/RDI ≥ 30 events/h). The performance levels of the BQ, SBQ, STOP, and ESS in detecting OSA of various severity levels are outlined as follows: for mild OSA, the pooled sensitivity levels were 76%, 88%, 87%, and 54%; pooled specificity levels were 59%, 42%, 42%, and 65%; and pooled DORs were 4.30, 5.13, 4.85, and 2.18, respectively. For moderate OSA, the pooled sensitivity levels were 77%, 90%, 89%, and 47%; pooled specificity levels were 44%, 36%, 32%, and 621%; and pooled DORs were 2.68, 5.05, 3.71, and 1.45, respectively. For severe OSA, the pooled sensitivity levels were 84%, 93%, 90%, and 58%; pooled specificity levels were 38%, 35%, 28%, and 60%; and pooled DORs were 3.10, 6.51, 3.37, and 2.10, respectively. Therefore, for mild, moderate, and severe OSA, the pooled sensitivity and DOR of the SBQ were significantly higher than those of other screening tools (P < .05); however, the specificity of the SBQ was lower than that of the ESS (P < .05). Moreover, age, sex, body mass index, study sample size, study populations, presence of comorbidities, PSG or portable monitoring performance, and risk of bias in the domains of the index test and reference standard were significant moderators of sensitivity and specificity (P < .05). Compared with the BQ, STOP, and ESS, the SBQ is a more accurate tool for detecting mild, moderate, and severe OSA. Sleep specialists should use the SBQ to conduct patient interviews for the early diagnosis of OSA in clinical settings, particularly in resource-poor countries and sleep clinics where PSG is unavailable.
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Affiliation(s)
- Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Pin-Yuan Chen
- Neurosurgical Department, Chang-Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Li-Pang Chuang
- School of Medicine, Chang-Gung University, Taoyuan, Taiwan; Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ning-Hung Chen
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Department of Public Health, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Jung Hsieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chi Wang
- Neurosurgical Department, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
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Elhefny RA, Mously SE, Sobhi S, Wahed WYA. Evaluation of sleep related breathing problems and sleep disturbances among health related employees at Fayoum University Hospitals. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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46
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Kawada T. Validation study of STOP-Bang score for screening sleep-disordered breathing. Sleep Breath 2016; 20:1093. [PMID: 27010811 DOI: 10.1007/s11325-016-1334-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan.
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47
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Lee SA, No YJ, Jo KD, Kwon JH, Kim JY, Han SH, Shin DJ. Subjective Sleep Disturbance in People with Epilepsy: Prevalence and Impact on Health-Related Quality of Life. SLEEP MEDICINE RESEARCH 2015. [DOI: 10.17241/smr.2015.6.1.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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