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Peñacoba P, Llauger MA, Fortuna AM, Flor X, Sampol G, Pedro-Pijoan AM, Grau N, Santiveri C, Juvanteny J, Aoiz JI, Bayó J, Lloberes P, Mayos M. A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study. BMC Pulm Med 2022; 22:38. [PMID: 35033055 PMCID: PMC8761286 DOI: 10.1186/s12890-022-01827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting. Methods Anthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the β coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed. Results 194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763–0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% ≥ 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863–0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7–92.1) and specificity of 67.8% (95% CI 55.1–78.3). Conclusions The use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment. Clinical Trial Registration Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979; Identifier: NCT02591979. Date of registration: October 30, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01827-0.
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Affiliation(s)
- Patricia Peñacoba
- Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Maria Antònia Llauger
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Equip d'Atenció Primària Encants, Centre d'Atenció Primària (CAP) Maragall, Institut Català de La Salut, Barcelona, Spain
| | - Ana María Fortuna
- Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Flor
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Chafarinas, Institut Català de La Salut, Barcelona, Spain
| | - Gabriel Sampol
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
| | | | - Núria Grau
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain.,Sleep Unit, Department of Respiratory Medicine, Parc de Salut Mar-IMIM, Hospital del Mar, Barcelona, Spain
| | - Carme Santiveri
- Service of Pneumology, Hospital Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain
| | - Joan Juvanteny
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CAP Trinitat Vella, Institut Català de La Salut, Barcelona, Spain
| | | | - Joan Bayó
- CAP El Clot, Institut Català de La Salut, Barcelona, Spain
| | - Patricia Lloberes
- Sleep Unit, Service of Pneumology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
| | - Mercè Mayos
- Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
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Mirghani H. The cross talk between chronotype, depression symptomatology, and glycaemic control among sudanese patients with diabetes mellitus: A case-control study. J Family Med Prim Care 2022; 11:330-335. [PMID: 35309608 PMCID: PMC8930107 DOI: 10.4103/jfmpc.jfmpc_656_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/07/2021] [Accepted: 11/01/2021] [Indexed: 11/09/2022] Open
Abstract
Aim of the Study: There is an increasing awareness about chronotype and depression among patients with diabetes mellitus as commonly ignored serious association. We aimed to investigate the same among patients with type 2 diabetes mellitus and their relation to glycaemic control. Subjects' and Methods: This case-control study conducted at two diabetes centers in Omdurman, Sudan during the period from April 2019 to September 2019. Ninety-two patient with type 2 diabetes and 94 controls signed a written informed consent then interviewed using a structured questionnaire based on the morningness–eveningness scale and the 12-item general health questionnaire; A blood sample was taken for the glycated haemoglobin to assess glycaemic control. The Statistical Package for Social Silences was used for Data analysis. Results: They were 92 patients with diabetes (58.7% women) and 94 healthy control subjects (52.1% women); matched for ages (57.03 ± 8.59 for diabetic patients and 58.46 ± 10.58 years for control subjects) and sex. Morning chronotype was reported in 95.3% vs. 47.5% and intermediate chronotype was evident in 52.4% vs. 4.3% in controls and patients respectively, P < 0.05. Depression symptomatology was found in 76.1% of patients with diabetes vs. 40.4% of control subjects, P < 0.05. No association was shown between depression symptomatology, chronotype, age, sex, and HbA1c, P > 0.05. Conclusion: Sudanese patients with diabetes were more likely intermediate, less morning chronotype, and more depressed compared to their counterparts. No association was found between depression symptomatology and other patient's characters. Larger studies investigating the risk behind depression, chrono-nutrition, and social jetlag among patients with diabetes are needed.
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Chapman JL, Hoyos CM, Killick R, Sutherland K, Cistulli PA, Zwar N, Yee BJ, Marks G, Grunstein RR, Wong KKH. Development and validation of a model for diagnosis of obstructive sleep apnoea in primary care. Respirology 2021; 26:989-996. [PMID: 34342088 DOI: 10.1111/resp.14122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/08/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Use of in-laboratory polysomnography (PSG) to diagnose obstructive sleep apnoea (OSA) is cost and resource intensive. Questionnaires, physical measurements and home monitors have been studied as potential simpler alternatives. This study aimed to develop a diagnostic model for OSA for use in primary care. METHODS Primary care practitioners were trained to recognize symptoms of sleep apnoea and recruited patients based on the clinical need to investigate OSA. Assessment was by symptom questionnaires, anthropomorphic measurements, digital facial photography, and a single-channel nasal flow monitor (Flow Wizard©, DiagnoseIT, Sydney, Australia) worn at home for 3 nights. The in-laboratory PSG was the reference test, with OSA defined as apnoea-hypopnoea index (AHI) ≥10 events/h. RESULTS In the model development phase, 25 primary care practitioners studied 315 patients in whom they suspected OSA, of which 57% had AHI≥10 and 22% had AHI≥30. Published OSA questionnaires provided low to moderate prediction of OSA (area under the curve [AUC] 0.53-0.73). The nasal flow monitor alone yielded high accuracy for predicting OSA with AUC of 0.87. Sensitivity was 0.87 and specificity 0.77 at a threshold respiratory event index (REI) of 18 events/h. A model adding age, gender, symptoms and BMI to the nasal flow monitor REI only modestly improved OSA prediction (AUC 0.89), with similar AUC (0.88) confirmed in the validation population of 114 patients. CONCLUSION Sleep apnoea can be diagnosed in the primary care setting with a combination of clinical judgement and portable monitor test outcomes.
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Affiliation(s)
- Julia L Chapman
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,School of Psychology and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,School of Psychology and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Roo Killick
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Kate Sutherland
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Peter A Cistulli
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Nick Zwar
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Brendon J Yee
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Guy Marks
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Charles Perkins Centre-Royal Prince Alfred Clinic, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Keith K H Wong
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Peñacoba P, Mayos M. Author response. J Clin Sleep Med 2020; 16:1631. [PMID: 32501208 DOI: 10.5664/jcsm.8634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Patricia Peñacoba
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mercè Mayos
- Sleep Unit, Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
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