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Ma J, Qiu X, Sun L, Cong N, Wei Y, Wei C, Huang J. Utility of the psychomotor vigilance task in screening for obstructive sleep apnoea. Eur Arch Otorhinolaryngol 2024; 281:3115-3123. [PMID: 38253905 DOI: 10.1007/s00405-023-08373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/23/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE The study aimed to assess the performance of the PVT in patients with suspected OSA, evaluate its role in population screening for OSA. METHODS The NoSAS, STOP-Bang, ESS scores and PVT tests were performed after suspected OSA patients' admission, followed by PSG. Then we compared the PVT results, calculated the sensitivity, specificity and ROC curve of PVT, and analyzed the accuracy of STOP-Bang and NoSAS questionnaire combined with PVT in predicting OSA. RESULTS A total of 308 patients were divided into four groups based on AHI: primary snoring (2.74 ± 1.4 events/h, n = 37); mild OSA (9.96 ± 3.25 events/h, n = 65); moderate OSA (22.41 ± 4.48 events/h, n = 76); and, severe OSA (59.42 ± 18.37 events/h, n = 130). There were significant differences in PVT lapses (p < 0.001) and reaction time (RT, p = 0.03) among the four groups. The PVT lapses and RT were positively correlated with AHI (p < 0.001) and ODI (p < 0.001), and negatively correlated with LSpO2 (p < 0.001). When diagnosing OSA (AHI ≥ 5 events/h), the AUCs of PVT, ESS, STOP-Bang, and NoSAS were 0.679, 0.579, 0.727, and 0.653, respectively; the AUCs of STOP-Bang and NoSAS combined with PVT increased. After combined PVT, the diagnostic specificity of STOP-Bang and NoSAS at nodes with AHI ≥ 5, ≥ 15 and ≥ 30 events/h increased to varying degrees. CONCLUSION Patients with OSA exhibited impairment in the PVT, and the combination of the PVT and STOP-Bang or NoSAS scores can improve the diagnostic efficacy and specificity for OSA.
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Affiliation(s)
- Jingru Ma
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Xihe Qiu
- Shanghai University of Engineering Science, Shanghai, People's Republic of China
| | - Lijie Sun
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Ning Cong
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yingchen Wei
- Shanghai University of Engineering Science, Shanghai, People's Republic of China
| | - Chunsheng Wei
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China.
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Room 205, Building 10, No. 83, Fenyang Road, Xuhui District, Shanghai, 200031, People's Republic of China.
| | - Jingjing Huang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China.
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Room 205, Building 10, No. 83, Fenyang Road, Xuhui District, Shanghai, 200031, People's Republic of China.
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Ma X, Zhang C, Wang Y, Yu K, Jin Z, Zhang C, Ma J, Liao J, Wang G. Correlation of morning dry mouth with clinical features of OSA in a community population: a cross-sectional study. Postgrad Med 2024; 136:30-35. [PMID: 38197225 DOI: 10.1080/00325481.2024.2303972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Morning dry mouth, commonly seen in Obstructive Sleep Apnea (OSA) patients, is absent in current OSA screening tools. This study evaluated the link between morning dry mouth and OSA's clinical symptoms and complications, aiming to determine its viability as a screening indicator. METHODS This research analyses baseline data from a prospective cohort study (the PIFCOPD study). Demographic information, medical history, and the presence of morning dry mouth symptoms were collected. The STOP-Bang questionnaire was performed for OSA screening. Logistic regression analyses were employed to establish the correlations between morning dry mouth and the clinical symptoms and comorbidities of OSA. RESULT 1291 participants (62.1±7.5 years; 501 males, 790 females) were included, of which 416 reported morning dry mouth (32.2%). 42.6% in the high-risk OSA group and 22.1% in the low-risk group reported morning dry mouth. Individuals with morning dry mouth also showed higher STOP-Bang scores (3.3±1.6 vs. 2.3±1.4, P<0.01). Significant associations were found between morning dry mouth and loud snoring, observed sleep apnea, daytime fatigue, and hyperlipidemia (P<0.01), but not with alcohol consumption, tea consumption, diabetes, or hypertension. CONCLUSION Morning dry mouth is associated with increased OSA risk and its clinical signs, suggesting its potential as an OSA screening symptom. CLINICAL TRIAL REGISTRATION This study has been registered at www.ClinicalTrials.gov (registration identifier: NCT03532893) on 21 May 2018.
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Affiliation(s)
- Xiaoyu Ma
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Cheng Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yunxia Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Kunyao Yu
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Zhe Jin
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Chunbo Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | | | - Jiping Liao
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
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Dakterzada F, Benítez ID, Targa A, Carnes A, Pujol M, Jové M, Mínguez O, Vaca R, Sánchez-de-la-Torre M, Barbé F, Pamplona R, Piñol-Ripoll G. Cerebrospinal fluid lipidomic fingerprint of obstructive sleep apnoea in Alzheimer's disease. Alzheimers Res Ther 2023; 15:134. [PMID: 37550750 PMCID: PMC10408111 DOI: 10.1186/s13195-023-01278-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) has a high prevalence in patients with Alzheimer's disease (AD). Both conditions have been shown to be associated with lipid dysregulation. However, the relationship between OSA severity and alterations in lipid metabolism in the brains of patients with AD has yet to be fully elucidated. In this context, we examined the cerebrospinal fluid (CSF) lipidome of patients with suspected OSA to identify potential diagnostic biomarkers and to provide insights into the pathophysiological mechanisms underlying the effect of OSA on AD. METHODS The study included 91 consecutive AD patients who underwent overnight polysomnography (PSG) to diagnose severe OSA (apnoea-hypopnea index ≥ 30/h). The next morning, CSF samples were collected and analysed by liquid chromatography coupled to mass spectrometry in an LC-ESI-QTOF-MS/MS platform. RESULTS The CSF levels of 11 lipid species were significantly different between AD patients with (N = 38) and without (N = 58) severe OSA. Five lipids (including oxidized triglyceride OxTG(57:2) and four unknown lipids) were significantly correlated with specific PSG measures of OSA severity related to sleep fragmentation and hypoxemia. Our analyses revealed a 4-lipid signature (including oxidized ceramide OxCer(40:6) and three unknown lipids) that provided an accuracy of 0.80 (95% CI: 0.71-0.89) in the detection of severe OSA. These lipids increased the discriminative power of the STOP-Bang questionnaire in terms of the area under the curve (AUC) from 0.61 (0.50-0.74) to 0.85 (0.71-0.93). CONCLUSIONS Our results reveal a CSF lipidomic fingerprint that allows the identification of AD patients with severe OSA. Our findings suggest that an increase in central nervous system lipoxidation may be the principal mechanism underlying the association between OSA and AD.
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Affiliation(s)
- Farida Dakterzada
- Unitat Trastorns Cognitius, Cognition and Behaviour Study Group, Santa Maria University Hospital, IRBLleida, Rovira Roure No. 44, Lleida, 25198, Spain
| | - Iván D Benítez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Madrid, Spain
| | - Adriano Targa
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Madrid, Spain
| | - Anna Carnes
- Unitat Trastorns Cognitius, Cognition and Behaviour Study Group, Santa Maria University Hospital, IRBLleida, Rovira Roure No. 44, Lleida, 25198, Spain
| | - Montse Pujol
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Mariona Jové
- Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida (UdL-IRBLleida), Lleida, Spain
| | - Olga Mínguez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Rafi Vaca
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Manuel Sánchez-de-la-Torre
- Department of Nursing and Physiotherapy, Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María, IRBLleida, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Madrid, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida (UdL-IRBLleida), Lleida, Spain
| | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius, Cognition and Behaviour Study Group, Santa Maria University Hospital, IRBLleida, Rovira Roure No. 44, Lleida, 25198, Spain.
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Wang Y, Fietze I, Salanitro M, Penzel T. Comparison of the value of the STOP-BANG questionnaire with oxygen desaturation index in screening obstructive sleep apnea in Germany. Sleep Breath 2023; 27:1315-1323. [PMID: 36269514 PMCID: PMC10427704 DOI: 10.1007/s11325-022-02727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Despite polysomnography being the gold standard method of diagnosing obstructive sleep apnea (OSA), it is time-consuming and has long waiting lists. Alternative methods including questionnaires and portable sleep devices have been developed to increase the speed of diagnosis. However, most questionnaires such as the STOP-BANG questionnaire (SBQ) are limited due to low specificity. This study evaluated the value of SBQ to screen for OSA and compared it with the oxygen desaturation index (ODI) and their combination. METHODS This retrospective study included patients who completed the SBQ and underwent a night at the sleep lab or home sleep testing. The ODI was extracted from these sleep study reports. The combination of SBQ with ODI and their individual scores were compared with apnea-hypopnea index (AHI) in terms of their accuracy in diagnosing OSA. Sensitivity, specificity, and area under the curve (AUC) for different severities of OSA were calculated and compared. RESULTS Among 132 patients, SBQ showed a sensitivity of 0.9 and a specificity of 0.3 to screen for OSA. As the severity of OSA increased, the sensitivity increased whilst specificity decreased for both measurements. ODI achieved an increased specificity of 0.8 and could correctly diagnose OSA 86% of the time which was better than SBQ's 60%. For all severities of OSA, ODI alone displayed a larger AUC than SBQ and similar AUC to their combination. CONCLUSION ODI produced a higher specificity and AUC than SBQ. Furthermore, ODI combined with SBQ failed to increase diagnostic value. Therefore, ODI may be the preferred way to initially screen patients for OSA as an easy-to-use alternative compared to SBQ.
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Affiliation(s)
- Yan Wang
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
- The Federal State Autonomous Educational Institution of Higher Education, I.M Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Matthew Salanitro
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité–Universitätsmedizin Berlin, Luisenstrasse 13, 10117 Berlin, Germany
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Betz K, Verhaert DVM, Gawalko M, Hermans ANL, Habibi Z, Pluymaekers NAHA, van der Velden RMJ, Homberg M, Philippens S, Hereijgers MJM, Vorstermans B, Simons SO, den Uijl DW, Chaldoupi SM, Luermans JGLM, Westra SW, Lankveld T, van Steenwijk RP, Hol B, Schotten U, Vernooy K, Hendriks JM, Linz D. Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: insights from the Virtual-SAFARI study. Clin Res Cardiol 2023; 112:834-845. [PMID: 36773038 PMCID: PMC10241725 DOI: 10.1007/s00392-023-02157-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients referred for atrial fibrillation (AF) catheter ablation (CA). Currently, it remains unclear how to improve pre-selection for SDB screening in patients with AF. AIM We aimed to (1) assess the accuracy of the STOP-Bang screening questionnaire for detection of SDB within an AF population referred for CA; (2) derive a refined, AF-specific SDB score to improve pre-selection. METHODS Consecutive AF patients referred for CA without a history of SDB and/or SDB screening were included. Patients were digitally referred to the previously implemented Virtual-SAFARI SDB screening and management pathway including a home sleep test. An apnoea-hypopnoea index (AHI) of ≥ 15 was interpreted as moderate-to-severe SDB. Logistic regression analysis was used to assess characteristics associated with moderate-to-severe SDB to refine pre-selection for SDB screening. RESULTS Of 206 included patients, 51% were diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (95% Confidence-Interval (CI) 0.573-0.721). AF-specific refinement resulted in the BOSS-GAP score. Therein, BMI with cut-off point ≥ 27 kg/m2 and previous stroke or transient ischaemic attack (TIA) were added, while tiredness and neck circumference were removed. The BOSS-GAP score performed better with an AUROC of 0.738 (95% CI 0.672-0.805) in the overall population. CONCLUSION AF-specific refinement of the STOP-Bang questionnaire moderately improved detection of SDB in AF patients referred for CA. Whether questionnaires bring benefits for pre-selection of SDB compared to structural screening in patients with AF requires further studies. TRIAL REGISTRATION NUMBER ISOLATION was registered NCT04342312, 13-04-2020.
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Affiliation(s)
- Konstanze Betz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Internal Medicine, Eifelklinik St. Brigida GmbH & Co. KG, Kammerbruchstraße 8, 52152, Simmerath, Germany
| | - Dominique V M Verhaert
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Monika Gawalko
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- 1St Department of Cardiology, Doctoral School, Medical University of Warsaw, Żwirki i Wigury 61, 02-091, Warsaw, Poland
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Forsthausweg 2, 47057, Duisburg, Germany
| | - Astrid N L Hermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Zarina Habibi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Rachel M J van der Velden
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Marloes Homberg
- Department of Anesthesiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Suzanne Philippens
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Maartje J M Hereijgers
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Bianca Vorstermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Sami O Simons
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Dennis W den Uijl
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Sjoerd W Westra
- Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Theo Lankveld
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | | | - Bernard Hol
- Netherland Sleep Institute, Computerweg 4, 3821 AB, Amersfoort, The Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Port Rd, Adelaide, SA, 5000, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, Adelaide, SA, 5042, Australia
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Port Rd, Adelaide, SA, 5000, Australia.
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, Adelaide, SA, 5042, Australia.
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Nørregade 10, 1165, Copenhagen, Denmark.
- Maastricht UMC+, Maastricht Heart+Vascular Center, 6202 AZ, Maastricht, The Netherlands.
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Lee JM, Lee HJ. Is sleep apnea truly associated with hearing loss? A nationwide, population-based study with STOP-BANG questionnaire. Front Public Health 2023; 11:1170470. [PMID: 37333523 PMCID: PMC10274574 DOI: 10.3389/fpubh.2023.1170470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives We aimed to investigate the effect of obstructive sleep apnea (OSA) on hearing ability. Methods We retrospectively reviewed the population-based survey data collected by the Korean National Health and Nutrition Examination Survey between January 1, 2019 and December 31, 2020. The data included 3,575 participants who completed the STOP-BANG questionnaire (SBQ) and pure-tone audiometry. OSA risk was assessed using the SBQ, and the hearing level was compared between the risk groups. Results Among the 3,575 participants, 2,152 (60.2%), 891 (24.9%), and 532 (14.9%) were classified as being low, intermediate, and high risk, respectively. The intermediate- and high-risk groups showed significantly worse hearing levels than the low-risk group. When age and sex were adjusted, the hearing level did not differ between the risk groups. Conclusion The study found that the presence of OSA minimally affected hearing level. Because hearing loss due to hypoxic damage develops over a long period of time, further research on the association between the duration of OSA, rather than the presence or severity of OSA, and hearing loss is needed.
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Affiliation(s)
- Jeon Mi Lee
- Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Hyun Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Dakterzada F, Benítez ID, Targa A, Carnes A, Pujol M, Jové M, Mínguez O, Vaca R, Sánchez-de-la-Torre M, Barbé F, Pamplona R, Piñol-Ripoll G. Blood-based lipidomic signature of severe obstructive sleep apnoea in Alzheimer's disease. Alzheimers Res Ther 2022; 14:163. [PMID: 36329512 PMCID: PMC9632042 DOI: 10.1186/s13195-022-01102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Background Obstructive sleep apnoea (OSA) is the most frequent form of sleep-disordered breathing in patients with Alzheimer’s disease (AD). Available evidence demonstrates that both conditions are independently associated with alterations in lipid metabolism. However, it is unknown whether the expression of lipids is different between AD patients with and without severe OSA. In this context, we examined the plasma lipidome of patients with suspected OSA, aiming to identify potential diagnostic biomarkers and to provide insights into the pathophysiological mechanisms underlying the disease. Methods The study included 103 consecutive patients from the memory unit of our institution with a diagnosis of AD. The individuals were subjected to overnight polysomnography (PSG) to diagnose severe OSA (apnoea-hypopnea index ≥30/h), and blood was collected the following morning. Untargeted plasma lipidomic profiling was performed using liquid chromatography coupled with mass spectrometry. Results We identified a subset of 44 lipids (mainly phospholipids and glycerolipids) that were expressed differently between patients with AD and severe and nonsevere OSA. Among the lipids in this profile, 30 were significantly correlated with specific PSG measures of OSA severity related to sleep fragmentation and hypoxemia. Machine learning analyses revealed a 4-lipid signature (phosphatidylcholine PC(35:4), cis-8,11,14,17-eicosatetraenoic acid and two oxidized triglycerides (OxTG(58:5) and OxTG(62:12)) that provided an accuracy (95% CI) of 0.78 (0.69–0.86) in the detection of OSA. These same lipids improved the predictive power of the STOP-Bang questionnaire in terms of the area under the curve (AUC) from 0.61 (0.50–0.74) to 0.80 (0.70–0.90). Conclusion Our results show a plasma lipidomic fingerprint that allows the identification of patients with AD and severe OSA, allowing the personalized management of these individuals. The findings suggest that oxidative stress and inflammation are potential prominent mechanisms underlying the association between OSA and AD. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-022-01102-8.
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Affiliation(s)
- Farida Dakterzada
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Santa Maria Lleida University Hospital, Rovira Roure n° 44, 25198, Lleida, Spain
| | - Iván D Benítez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Madrid, Spain
| | - Adriano Targa
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Madrid, Spain
| | - Anna Carnes
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Santa Maria Lleida University Hospital, Rovira Roure n° 44, 25198, Lleida, Spain
| | - Montse Pujol
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Mariona Jové
- Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida (UdL-IRBLleida), E25198, Lleida, Spain
| | - Olga Mínguez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Rafi Vaca
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Manuel Sánchez-de-la-Torre
- Department of Nursing and Physiotherapy, Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María, IRBLleida, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Madrid, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida (UdL-IRBLleida), E25198, Lleida, Spain
| | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Santa Maria Lleida University Hospital, Rovira Roure n° 44, 25198, Lleida, Spain.
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Zheng Z, Zhang Y, Chen M, Chen X, Li C, Wang C, Zhu J, Lin J, Ou X, Zou Z, Wang Z, Deng J, Chen R, Wang Z, Zheng Z, Wu K, Chen R. Application value of joint STOP-Bang questionnaire and Epworth Sleepiness Scale in screening for obstructive sleep apnea. Front Public Health 2022; 10:950585. [PMID: 36267990 PMCID: PMC9578009 DOI: 10.3389/fpubh.2022.950585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/01/2022] [Indexed: 01/21/2023] Open
Abstract
Objective This paper evaluates the application value of the STOP-Bang questionnaire combined with the Epworth Sleepiness Scale (ESS) in screening for obstructive sleep apnea (OSA) in the population. Method Thousand-six hundred seventy-one patients with suspected OSA who visited the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from August 2017 to August 2020 were monitored by overnight polysomnography (PSG) after completing the ESS scale and STOP-Bang questionnaire. The sensitivity, specificity, positive predictive value, negative predictive value and receiver operating characteristic (ROC) curves of the two scales were calculated, and the accuracy in predicting OSA of the STOP-Bang questionnaire combined with ESS was analyzed. Results With Apnea Hypopnea Index (AHI) cutoffs of ≥5, ≥15 and ≥30 events/h, the areas under the ROC curve scored by STOP-Bang were 0.724, 0.703 and 0.712, and those of ESS were 0.632, 0.634 and 0.695; the diagnostic odds ratio (DOR) values of STOP-Bang for OSA, moderate to severe OSA, and severe OSA were 3.349, 2.651 and 3.189, and those of ESS were 2.665, 2.279 and 3.289. The STOP-Bang score of three was used as the cut-off point for OSA diagnosis with higher sensitivity and lower specificity, while ESS had higher specificity. STOP-Bang (≥3) combined with ESS significantly improved its specificity for predicting OSA. Conclusion The STOP-Bang questionnaire is a simple and effective new tool for screening patients for OSA, while a STOP-Bang score of ≥3 combined with ESS can further improve its specificity. Thus, we suggest further screening with ESS after a STOP-Bang score of ≥3 in suspected patients.
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Affiliation(s)
- Zhenzhen Zheng
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yitao Zhang
- Yangjiang Hospital of Traditional Chinese Medicine, Yangjiang, China
| | - Mingdi Chen
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaojuan Chen
- Medical College of Jiaying University, Meizhou, China
| | - Chunhe Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chaoyu Wang
- Taishan Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Jinru Zhu
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Junyan Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Xudong Ou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Zhihong Zou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Zhiwei Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Junzhong Deng
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China,*Correspondence: Junzhong Deng
| | - Riken Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China,Riken Chen
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Mira Quirós MD, Maimó Bordoy A, El Haji K, Aguilar Sánchez JL, Tejada Gavela S. Cross-cultural adaptation and validation of the STOP-bang Questionnaire from English to Spanish as a tool for the early detection of sleep apnea syndrome in the surgical patient and in the general population. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:393-401. [PMID: 35871142 DOI: 10.1016/j.redare.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/27/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Obstructive Sleep Apnea Syndrome (OSAS) or Apnea-Hypoapnea Syndrome (SAHS) is one of the most prevalent sleep disorders in the general population. It is associated with an increase in the prevalence of difficult orotracheal intubation and postoperative complications. The application of validated early detection tests, such the STOPbang test in English (STBC), is recommended; a test of high methodological quality, sensitivity and specificity in the early detection of SAHS in both surgical and general populations. OBJECTIVE The validation, translation, cross-cultural adaptation of the STBC to the Spanish population. MATERIAL AND METHODS The transcultural adaptation of the STBC to Spanish was carried out and a subsequent validation study with 77 consecutive patients was carried out. The statistical analysis evaluated the reliability, validity and feasibility of the translated and culturally adapted version. RESULTS 44% of women and 56% of men were included, with a mean age of 53.58 ± 12.88 years. The reliability results were: a Cronbach's Alpha Coefficient of 0.767, a Pearson correlation r = 0.777 (P < .001) and a Sperman correlation rho = 0.455 (P = .044). The feasibility of the study was 100%. Criterion validity was evaluated using the Kappa coefficient, which was 0.444. For a score >3 of the questionnaire adapted to Spanish, the results of sensitivity, specificity according to the different cut-off levels of the apnea hypopnea index (AHI) >5, >15, >30) were: Sensitivity 87%, 91% and 100% respectively and Specificity of 50%, 31% and 22%. CONCLUSIONS The STBC questionnaire translated, adapted and validated into Spanish, evaluated in the present study, is reliable and valid with respect to the original design of the questionnaire. It is a useful tool that is easy to understand and implement, which can be used rigorously to stratify surgical risk and carry out adequate perioperative planning of those patients at risk of SAHS.
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Affiliation(s)
- M D Mira Quirós
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Son Llàtzer, Palma, Balearic Islands, Spain.
| | - A Maimó Bordoy
- Servicio de Neumología, Hospital Universitario Son Llàtzer, Palma, Balearic Islands, Spain
| | - K El Haji
- Unidad de Investigación, Hospital Universitario Son Llàtzer, Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain
| | - J L Aguilar Sánchez
- Facultad de Medicina, Universidad de las Islas Baleares, Palma, Balearic Islands, Spain
| | - S Tejada Gavela
- Facultad de Medicina, Universidad de las Islas Baleares, Palma, Balearic Islands, Spain
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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. Arch Environ Occup 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kazubowska-Machnowska K, Jodkowska A, Michalek-Zrabkowska M, Wieckiewicz M, Poreba R, Dominiak M, Gac P, Mazur G, Kanclerska J, Martynowicz H. The Effect of Severity of Obstructive Sleep Apnea on Sleep Bruxism in Respiratory Polygraphy Study. Brain Sci 2022; 12:brainsci12070828. [PMID: 35884635 PMCID: PMC9313411 DOI: 10.3390/brainsci12070828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023] Open
Abstract
Obstructive sleep apnea (OSA) and sleep bruxism (SB) may appear concomitantly. Data on the relationship between OSA and SB are limited. It was shown that in a population with an increased risk of OSA, OSA was dependently correlated with SB on the degree of OSA severity only in mild and moderate cases of OSA. We aimed to confirm this relationship and affecting factors in a group of dental office patients in a prospective, observational study. Adult patients (n = 119) were evaluated using respiratory polygraphy. The risk of OSA was assessed using a STOP-Bang questionnaire (SBQ). The episodes of bruxism and respiratory events were scored according to the standards of the American Academy of Sleep Medicine. The prevalence of OSA and SB was found to be 63.02% and 41.17%, respectively. The bruxism episode index (BEI) was increased in the group with a higher risk of OSA (SBQ ≥ 3) compared to the group with a lower risk of OSA (3.49 ± 3.63 vs. 2.27 ± 2.50, p = 0.03). The sensitivity and specificity of the SBQ were not sufficient to predict SB. A positive linear correlation between AHI and BEI in the group with AHI < 23/h was found. The study confirmed that OSA was associated with SB in the group of patients with OSA and/or SB risk. The relationship between OSA and SB depended on the degree of severity of OSA and occurred in mild and moderate cases of OSA.
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Affiliation(s)
| | - Anna Jodkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
- Correspondence: ; Tel.: +48-71-736-4000
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland;
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Marzena Dominiak
- Department of Oral Surgery, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland; (K.K.-M.); (M.D.)
| | - Pawel Gac
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, 7 Mikulicza-Radeckiego St., 50-345 Wroclaw, Poland;
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Justyna Kanclerska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
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Sun X, Zheng Z, Chen R, Huang H, Lei W, Peng M, Li X, Zhang N, Cheng J. The influence of sex on anthropometric methods and four scales for screening obstructive sleep apnea. Auris Nasus Larynx 2021:S0385-8146(21)00268-6. [PMID: 34895942 DOI: 10.1016/j.anl.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/16/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Obstructive Sleep Apnea (OSA) is a kind of respiratory disease that occurs apnea repeatedly during sleep. The purpose of this study was to investigate the influence of sex on anthropometric methods and four scales for screening OSA. METHODS The basic data and PSG data of 2108 patients who underwent PSG examination at the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from July 2017 to December 2020 were continuously included. Then the sensitivity, specificity, positive predictive value, negative predictive value, AUC and DOR of the anthropometric method and the four scales were calculated. RESULTS 2108 OSA patients were enrolled from the Sleep Medicine Center, including 1644 males (78.0%). The average neck circumference and waist circumference of male and female patients were respectively (39.4±3.4) cm and (96.7±13.8) cm,(34.6±3.5) cm and (90.1±11.6) cm. In female patients. the AUC of NoSAS was the largest. When AHI was 5, 15, and 30 evens/h as the cut-off point, in male patients, the sensitivity of NHR was the highest,in female patients, the sensitivity of WHR was the highest. CONCLUSIONS NHR and WHR are good tools for screening OSA in male and female patients respectively. They are worthy of promotion.
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Mayer A, Mizdrak M, Babić M, Mastelić T, Glavina T, Božić J, Kurir TT. Knowledge, Attitudes, and Screening for Obstructive Sleep Apnea and Diabetes Mellitus among War Veterans Seeking Treatment of Posttraumatic Stress Disorder. Healthcare (Basel) 2021; 9:healthcare9121698. [PMID: 34946424 PMCID: PMC8700977 DOI: 10.3390/healthcare9121698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders. However, we should not neglect the somatic aspects of PTSD. Associations with cardiovascular diseases (CVD) are particularly concerning because PTSD was associated with an even 53% higher risk for CVD. This study aimed to analyze the prevalence of several CVD risk factors, especially diabetes mellitus among PTSD patients divided into three groups according to obstructive sleep apnea (OSA) risk stratification (low, intermediate, and high). This cross-sectional study included one hundred male PTSD veterans. The mean age was 53 (40-67) years. The estimated OSA risk was 95% for the whole cohort, and 53% were in the high-risk group. Median HbA1c was 5.6 (4.6-10)%. The hemoglobin A1c (HbA1c) levels showed that 34 patients were in the prediabetes group, and 20 of them fulfilled the criteria for diabetes. However, only 13 of them were aware of their previous diagnosis of diabetes mellitus. In testing knowledge about diabetes, 62% and only 23% of patients knew the correct definition of HbA1c and level of fasting plasma glucose, respectively. Diabetic patients had insufficient knowledge about diabetic complications and treatment. A higher level of PTSD symptoms in veterans was associated with a higher prevalence of OSA. The results strongly support further research and education into early detection of CVD risk factors associated with PTSD.
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Affiliation(s)
- Ante Mayer
- Health Centre of Split-Dalmatia County, 21000 Split, Croatia;
| | - Maja Mizdrak
- Department of Nephrology and Hemodialysis, University Hospital of Split, 21000 Split, Croatia;
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (J.B.); (T.T.K.)
- Correspondence: ; Tel.: +385-(0)21-557-298
| | - Marija Babić
- Department of Nephrology and Hemodialysis, University Hospital of Split, 21000 Split, Croatia;
| | - Tonći Mastelić
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.M.); (T.G.)
| | - Trpimir Glavina
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.M.); (T.G.)
| | - Joško Božić
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (J.B.); (T.T.K.)
| | - Tina Tičinović Kurir
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (J.B.); (T.T.K.)
- Department of Endocrinology, Diabetes and Metabolic Disorders, University Hospital of Split, 21000 Split, Croatia
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Guess NW, Fischbach H, Ni AA, Firestone AR. Referral rate for obstructive sleep apnea in a pre-doctoral dental clinic using the STOP-Bang Questionnaire. J Dent Educ 2021; 86:456-462. [PMID: 34796488 DOI: 10.1002/jdd.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is a common condition that can result in significant illness when untreated. Only 10%-20% of individuals with OSA are believed to be properly diagnosed. Consequently, dentists are encouraged to identify patients at high risk for OSA. The aim of this study was to determine whether patients in a dental school student clinic were referred for evaluation of OSA when appropriate. MATERIALS AND METHODS All patients 18 or older admitted to the College of Dentistry between July 2017 and March 2020 completed a medical history form. Data were extracted from their responses to determine a STOP-Bang score, as well as data regarding a previous diagnosis of OSA and a list of referrals. Students are expected to refer patients appropriately where there are indications of a high risk of undiagnosed disease. In the case of a sleep apnea evaluation, this would include any patient whose STOP-Bang score was 5 or greater, per the lecture on sleep disorders. For patients identified as high risk, notes and referral forms were reviewed to determine if the appropriate referral occurred. RESULTS Of the 21,312 new patients, 1098 (5.2%) were identified as high-risk for OSA. Of those, 398 (36%) had not been previously diagnosed with OSA. None of these 398 patients received a referral for further evaluation of OSA. CONCLUSION The rate of referral for further evaluation for patients deemed at high risk for OSA was inadequate. Continued education and changes to the electronic health record are needed to ensure those at high-risk for OSA are appropriately managed.
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Affiliation(s)
- Nathan William Guess
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - Henry Fischbach
- Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - Andy A Ni
- Department of Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Allen R Firestone
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
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Pei C, Gui S. Effect of arterial blood bicarbonate (HCO 3-) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea. BMC Pulm Med 2021; 21:366. [PMID: 34774046 PMCID: PMC8590281 DOI: 10.1186/s12890-021-01720-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the effect of arterial bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire (SBQ) screening for obstructive sleep apnea (OSA). Methods A total of 144 patients with suspected OSA were included. Polysomnograms (PSG) and blood gas analysis were performed, and the Epworth Sleepiness Scale (ESS), STOP-Bang questionnaire, and Berlin questionnaire were completed. The correlation between the arterial HCO3− concentration, apnea hypopnea index (AHI), and other related indicators was analyzed. The scoring results of the ESS, SBQ, and Berlin questionnaire were compared with the PSG results, and the sensitivity and specificity were calculated in the form of a four-cell table. The changes in the sensitivity and specificity of OSA screening after SBQ alone and combined with HCO3− concentration were compared, and ROC curves were drawn. Results Arterial HCO3− concentration was positively correlated with AHI (r = 0.537, P < 0.001). The ratio of HCO3− concentration ≥ 24.6 mmol/L in the non-OSA group was significantly lower than that in the OSA group (25.0% VS 80.8%, P < 0.001). The sensitivity of the SBQ was higher than that of the ESS (97.5% VS 81.7%, P < 0.001) and the Berlin questionnaire (97.5% VS 79.2%, P < 0.001). There was no statistical significance in the specificity of the three scales (25%, 37.5%, 37.5%). A combined SBQ score ≥ 3 and HCO3− concentration ≥ 24.6 mmol/L showed increased specificity and decreased sensitivity compared with an SBQ score ≥ 3 alone, with a corresponding AUC of 0.771 (P < 0.01) and 0.613 (P > 0.05), respectively. Conclusion The sensitivity of the SBQ was better than that of the Berlin questionnaire and ESS. After combining arterial blood HCO3− concentration, the SBQ questionnaire increased the specificity of OSA prediction and decreased the sensitivity, which improved the accuracy of screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01720-2.
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Affiliation(s)
- Chong Pei
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, No. 81 of Mei Shan Road, Hefei, 230001, Anhui, People's Republic of China.,Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), No. 390 of Huai He Road, Hefei, 230001, Anhui, People's Republic of China
| | - Shuyu Gui
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, No. 81 of Mei Shan Road, Hefei, 230001, Anhui, People's Republic of China.
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Sangkum L, Wathanavaha C, Tantrakul V, Pothong M, Karnjanarachata C. Modified STOP-Bang for predicting perioperative adverse events in the Thai population. BMC Anesthesiol 2021; 21:132. [PMID: 33906600 PMCID: PMC8077766 DOI: 10.1186/s12871-021-01347-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Undiagnosed obstructive sleep apnea (OSA) is associated with adverse perioperative outcomes. The STOP-Bang questionnaire is a validated screening tool for OSA. However, its precision may vary among different populations. This study determined the association between high-risk OSA based on the modified STOP-Bang questionnaire and perioperative adverse events. Methods This cross-sectional study included patients undergoing elective surgery from December 2018 to February 2019. The modified STOP-Bang questionnaire includes a history of Snoring, daytime Tiredness, Observed apnea, high blood Pressure, Body mass index > 30 kg/m2, Age > 50, Neck circumference > 40 cm, and male Gender. High risk for OSA was considered as a score ≥ 3. Results Overall, 400 patients were included, and 18.3% of patients experienced perioperative adverse events. On the basis of modified STOP-Bang, the incidence of perioperative adverse events was 23.2 and 13.8% in patients with high risk and low risk (P-value 0.016) (Original STOP-Bang: high risk 22.5% vs. low risk 14.7%, P-value 0.043). Neither modified nor original STOP-Bang was associated with perioperative adverse events (adjusted OR 1.91 (95% CI 0.99–3.66), P-value 0.055) vs. 1.69 (95%CI, 0.89–3.21), P-value 0.106). Modified STOP-Bang ≥3 could predict the incidence of difficult ventilation, laryngoscopic view ≥3, need for oxygen therapy during discharge from postanesthetic care unit and ICU admission. Conclusions Neither modified nor original STOP-Bang was significantly associated with perioperative adverse events. However, a modified STOP-Bang ≥3 can help identify patients at risk of difficult airway, need for oxygen therapy, and ICU admission. Trial registrations This study was registered on Thai Clinical Trials Registry, identifier TCTR20181129001, registered 23 November 2018 (Prospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01347-0.
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Affiliation(s)
- Lisa Sangkum
- 270 Department of Anesthesiology, Faculty of Medicine, Ramathibodi hospital, Mahidol University, Rama VI road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand.
| | - Chama Wathanavaha
- 270 Department of Anesthesiology, Faculty of Medicine, Ramathibodi hospital, Mahidol University, Rama VI road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
| | - Visasiri Tantrakul
- 270 Sleep Disorder Center and Division of Pulmonary and Critical Care, Medicine Department, Ramathibodi hospital, Mahidol University, Rama VI road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
| | - Munthana Pothong
- 270 Sleep Disorder Center and Division of Pulmonary and Critical Care, Medicine Department, Ramathibodi hospital, Mahidol University, Rama VI road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
| | - Cherdkiat Karnjanarachata
- 270 Department of Anesthesiology, Faculty of Medicine, Ramathibodi hospital, Mahidol University, Rama VI road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
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Pangerc A, Petek Šter M, Dolenc Grošelj L. Translation and validation of the STOP-Bang questionnaire into Slovene. Eur J Med Res 2021; 26:32. [PMID: 33827701 PMCID: PMC8025340 DOI: 10.1186/s40001-021-00503-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To translate, culturally adapt and evaluate the Slovene version of the STOP-Bang questionnaire (SBQ) for use in the sleep clinic. Methods Standard forward–backward translation and harmonisation of the Slovene translation of the SBQ were performed. Test–retest reliability was performed on a sample of healthy subjects. A cross-sectional study was performed with patients referred for a sleep study. Patients filled out the Slovene translation of the SBQ before undergoing sleep study. Results The validation group consisted of 256 patients, of which 237 (92.6%) were included. Mean age was 52.5 ± 14.6, 63.3% of patients were male. Obstructive sleep apnoea (OSA) (apnoea–hypopnea index (AHI) ≥ 5) was present in 69.6% of patients, of whom 22.4% had mild (AHI ≥ 5 and < 15), 21.9% moderate (AHI ≥ 15 and < 30), and 25.3% severe (AHI ≥ 30) OSA. A SBQ score of 3 had a sensitivity of 92.1 (86.9–95.7), specificity of 44.4 (32.7–56.6), PPV of 79.2 (75.5–82.4) and AUC of 0.757 (95% CI 0.692–0.823; p < 0.001) for all OSA (AHI ≥ 5). Each increase in the SBQ score was associated with an increase in the probability of OSA. Conclusion This study shows that the Slovene version of the SBQ is a valid tool for evaluating the risk of OSA in a sleep clinic. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-021-00503-z.
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Affiliation(s)
| | - Marija Petek Šter
- Community Health Centre Trebnje, Trebnje, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Leja Dolenc Grošelj
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Reibel Y, Flynn DN, Petersen A, Flynn PM. Acceptance of Dental Office Obstructive Sleep Apnea Screening among Minnesota State Fair Attendees. J Dent Hyg 2021; 95:36-42. [PMID: 33627451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 02/26/2020] [Indexed: 06/12/2023]
Abstract
Purpose: Obstructive sleep apnea (OSA) is a common breathing disorder; however, many individuals remain undiagnosed. The purpose of this study was to assess the comfort level of community-dwelling adults to participate in OSA screening in a dental office setting and survey the OSA risk levels of an adult population.Methods: This cross-sectional study was conducted among adults presenting at the University of Minnesota Driven to Discover Research Facility during the 2018 Minnesota State Fair. Participants completed a brief survey including the eight-item STOP-Bang questionnaire for OSA screening. Electronic tablets were used for data capture. Data analyses included descriptive statistics, t-tests, and Chi-square tests.Results: A total of 639 adults met the survey inclusion criteria (n=639). The majority of participants (88%) reported no prior OSA diagnosis. Based on STOP-Bang criteria, 61% (n=344) of the participants were at low, 29% (n=161) intermediate, and 10% (n= 56) high risk of OSA. A majority (64%) of participants reported being either "comfortable" or "very comfortable'"with OSA screening performed in a dental office setting.Conclusion: Over one third of participants with no prior OSA diagnosis were at moderate to high risk for OSA, and the majority stated that they would be comfortable undergoing OSA screening in a dental office setting. Dental hygienists screening patients for OSA with the STOP-BANG questionnaire are likely to have a high level of patient acceptance. Referring patients to the appropriate health care provider for further testing may increase timely diagnoses and treatment of OSA.
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Affiliation(s)
- Yvette Reibel
- Assistant clinical professor, Division of Dental Hygiene, Department of Primary Dental Care, University of Minnesota School of Dentistry, Minneapolis, MN, USA;
| | - David N Flynn
- Assistant clinical professor, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley Petersen
- Assistant professor, Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Priscilla M Flynn
- Associate professor, Division of Dental Hygiene, Department of Primary Dental Care, University of Minnesota School of Dentistry, Minneapolis, MN, USA
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Chen L, Pivetta B, Nagappa M, Saripella A, Islam S, Englesakis M, Chung F. Validation of the STOP-Bang questionnaire for screening of obstructive sleep apnea in the general population and commercial drivers: a systematic review and meta-analysis. Sleep Breath 2021. [PMID: 33507478 DOI: 10.1007/s11325-021-02299-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
Purpose Obstructive sleep apnea (OSA) is a critical occupational health concern, but is often undiagnosed in the general population and commercial drivers. The STOP-Bang questionnaire is a simple, reliable tool to screen for OSA, which could improve public health in a cost-effective manner. The objective of this systematic review and meta-analysis is to assess the validity of the STOP-Bang questionnaire to detect OSA in these key populations. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Journals @ Ovid, Web of Science, Scopus, and CINAHL for relevant articles from 2008 to March 2020. The quality of studies was appraised using Cochrane Methods criteria. To calculate pooled predictive parameters, we created 2 × 2 contingency tables and performed random-effects meta-analyses. Results Of 3871 citations, five studies that evaluated STOP-Bang in the general population (n = 8585) and two in commercial drivers (n = 185) were included. In the general population, prevalence of all OSA (AHI ≥ 5), moderate-to-severe OSA (AHI ≥ 15), and severe OSA (AHI ≥ 30) was 57.6%, 21.3%, and 7.8% respectively. In commercial drivers, the prevalence of moderate-to-severe OSA was 37.3%. The trends of high sensitivity and negative predictive value of a STOP-Bang score ≥ 3 illustrates that the questionnaire helps detect and rule out clinically significant OSA in the general population and commercial drivers. Conclusion This meta-analysis demonstrates that the STOP-Bang questionnaire is a valid and effective screening tool for OSA in the general population and commercial drivers. Trial registration PROSPERO No. CRD42020200379; 08/22/2020 Supplementary Information The online version contains supplementary material available at 10.1007/s11325-021-02299-y.
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21
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Veugen CCAFM, Teunissen EM, den Otter LAS, Kos MP, Stokroos RJ, Copper MP. Prediction of obstructive sleep apnea: comparative performance of three screening instruments on the apnea-hypopnea index and the oxygen desaturation index. Sleep Breath 2020; 25:1267-1275. [PMID: 33098537 PMCID: PMC8376723 DOI: 10.1007/s11325-020-02219-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/03/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
Purpose To evaluate the performance of the NoSAS (neck, obesity, snoring, age, sex) score, the STOP-Bang (snoring, tiredness, observed apneas, blood pressure, body mass index, age, neck circumference, gender) questionnaire, and the Epworth sleepiness score (ESS) as a screening tool for obstructive sleep apnea (OSA) severity based on the apnea-hypopnea index (AHI) and the oxygen desaturation index (ODI). Methods Data from 235 patients who were monitored by ambulant polysomnography (PSG) were retrospectively analyzed. OSA severity was classified based on the AHI; similar classification categories were made based on the ODI. Discrimination was assessed by the area under the curve (AUC), while predictive parameters were calculated by four-grid contingency tables. Results The NoSAS score and the STOP-Bang questionnaire were both equally adequate screening tools for the AHI and the ODI with AUC ranging from 0.695 to 0.767 and 0.684 to 0.767, respectively. Both questionnaires perform better when used as a continuous variable. The ESS did not show adequate discrimination for screening for OSA (AUC ranging from 0.450 to 0.525). Male gender, age, and BMI proved to be the strongest individual predictors in this cohort. Conclusion This is the first study to evaluate the predictive performance of three different screening instruments with respect to both the AHI and the ODI. This is important, due to increasing evidence that the ODI may have a higher reproducibility in the clinical setting. The NoSAS score and the STOP-Bang questionnaire proved to be equally adequate to predict OSA severity based on both the AHI and the ODI. Electronic supplementary material The online version of this article (10.1007/s11325-020-02219-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christianne C A F M Veugen
- Department of Otorhinolaryngology Head and Neck surgery, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
- Department of Otorhinolaryngology Head and Neck surgery, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Emma M Teunissen
- Department of Otorhinolaryngology Head and Neck surgery, Radboud Universitair Medisch Centrum, Geert Groteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Leontine A S den Otter
- Faculty of Medicine, Universitair Medisch Centrum Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Martijn P Kos
- Ruysdael Sleepclinic, Ruysdaelstraat 49 A1-D, 1071 XA, Amsterdam, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology Head and Neck surgery, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marcel P Copper
- Department of Otorhinolaryngology Head and Neck surgery, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
- Ruysdael Sleepclinic, Ruysdaelstraat 49 A1-D, 1071 XA, Amsterdam, The Netherlands
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陈 曦, 章 榕, 贾 金, 袁 伟, 李 进. [A modified STOP-Bang questionnaire for OSA screening in the young, middle-age women]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:811-814. [PMID: 33040505 PMCID: PMC10127730 DOI: 10.13201/j.issn.2096-7993.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Indexed: 06/11/2023]
Abstract
Objective:The STOP-Bang(S-B) questionnaire is widely used for screening patients with OSA. However, BMI and NC cutoff value in the original S-B questionnaire is 35 kg/m²and 40cm, the BMI and NC value in the young and middle-aged female patients in China is lower than that. We aimed to establish a more appropriate modified STOP-Bang(MS-B) questionnaire. Method:A total of 523 cases with suspected OSA in the young and middle-aged female were included in this study. All patients were asked to completed the S-B, MS-B questionnaire and undergo overnight polysomnography(PSG). The BMI and NC value of the MS-B were determined by the optimal operating points of the ROC. The ability of S-B and MS-B were assessed by ROC and McNemar's test. Result:BMI=28 kg/m²and NC=36 cm as alternative cutoff is to refine S-B questionnaire. When taking apnea hypopnea index(AHI) ≥5 times/h, ≥15 times/h and ≥30 times/h as cut-offs, MS-B had higher sensitivity(88.7% vs 86.7%, 92.8% vs 87.7%, 95.0% vs 90.1%, respectively) and the area under the curve(0.74 vs 0.706, 0.734 vs 0.703, 0.739 vs 0.699, respectively) than S-B. There were significant differences in McNemar test(P<0.05). Conclusion:This study examined the clinical utility of MS-B. MS-B may improve predictive performance of S-B questionnaire in the young and middle-aged female with OSA.
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Affiliation(s)
- 曦 陈
- 中国人民解放军总医院第六医学中心耳鼻咽喉头颈外科(北京,100048)Department of Otolaryngology Head and Neck Surgery, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
| | - 榕 章
- 中国人民解放军总医院第六医学中心耳鼻咽喉头颈外科(北京,100048)Department of Otolaryngology Head and Neck Surgery, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
| | - 金文 贾
- 新疆医科大学第五附属医院耳鼻喉科Department of Otolaryngology, the Fifth Affiliated Hospital of Xinjiang Medical University
| | - 伟 袁
- 中国人民解放军总医院第六医学中心耳鼻咽喉头颈外科(北京,100048)Department of Otolaryngology Head and Neck Surgery, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
| | - 进让 李
- 中国人民解放军总医院第六医学中心耳鼻咽喉头颈外科(北京,100048)Department of Otolaryngology Head and Neck Surgery, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
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Lonia L, Scalese M, Rossato G, Bruno G, Zalunardo F, De Stefani A, Gracco A. Validity of the STOP-Bang Questionnaire in Identifying OSA in a Dental Patient Cohort. ACTA ACUST UNITED AC 2020; 56:E324. [PMID: 32629852 DOI: 10.3390/medicina56070324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Caplan IF, Glauser G, Goodrich S, Chen HI, Lucas TH, Lee JYK, McClintock SD, Malhotra NR. Undiagnosed Obstructive Sleep Apnea as Predictor of 90-Day Readmission for Brain Tumor Patients. World Neurosurg 2019; 134:e979-e984. [PMID: 31734423 DOI: 10.1016/j.wneu.2019.11.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previously undiagnosed obstructive sleep apnea (OSA) is a known contributor to negative postoperative outcomes. The STOP-Bang questionnaire is a screening tool for OSA that has been validated in both medical and surgical populations. The authors have previously studied this screening tool in a brain tumor population at 30 days. The present study seeks to investigate the effectiveness of this questionnaire, for predicting 90-day readmissions in a population of brain tumor patients with previously undiagnosed OSA. METHODS Included for analysis were all patients undergoing craniotomy for supratentorial neoplasm at a multihospital, single academic medical center. Data were collected from supratentorial craniotomy cases for which the patient was alive at 90 days after surgery (n = 238). Simple logistic regression analyses were used to assess the ability of the STOP-Bang questionnaire and subsequent single variables to accurately predict patient outcomes at 90 days. RESULTS The sample included 238 brain tumor admissions, of which 50% were female (n = 119). The average STOP-Bang score was 1.95 ± 1.24 (range 0-7). A 1-unit higher increase in STOP-Bang score accurately predicted 90-day readmissions (odds ratio [OR] = 1.65, P = 0.001), 30- to 90-day emergency department visits (OR = 1.85, P < 0.001), and 30- to 90-day reoperation (OR = 2.32, P < 0.001) with fair accuracy as confirmed by the receiver operating characteristic (C-statistic = 0.65-0.76). However, the STOP-Bang questionnaire did not correlate with home discharge (P = 0.315). CONCLUSIONS The results of this study suggest that undiagnosed OSA, as evaluated by the STOP-Bang questionnaire, is an effective predictor of readmission risk and health system utilization in a brain tumor craniotomy population with previously undiagnosed OSA.
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Affiliation(s)
- Ian F Caplan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Gregory Glauser
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Stephen Goodrich
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, USA; The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania, USA
| | - H Isaac Chen
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Timothy H Lucas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA.
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Caplan IF, Glauser G, Goodrich S, Chen HI, Lucas TH, Lee JYK, McClintock SD, Malhotra NR. Undiagnosed obstructive sleep apnea as a predictor of 30-day readmission for brain tumor patients. J Neurosurg 2019; 133:1-6. [PMID: 31323636 DOI: 10.3171/2019.4.jns1968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is known to be associated with negative outcomes and is underdiagnosed. The STOP-Bang questionnaire is a screening tool for OSA that has been validated in both medical and surgical populations. Given that readmission after surgical intervention is an undesirable event, the authors sought to investigate, among patients not previously diagnosed with OSA, the capacity of the STOP-Bang questionnaire to predict 30-day readmissions following craniotomy for a supratentorial neoplasm. METHODS For patients undergoing craniotomy for treatment of a supratentorial neoplasm within a multiple-hospital academic medical center, data were captured in a prospective manner via the Neurosurgery Quality Improvement Initiative (NQII) EpiLog tool. Data were collected over a 1-year period for all supratentorial craniotomy cases. An additional criterion for study inclusion was that the patient was alive at 30 postoperative days. Statistical analysis consisted of simple logistic regression, which assessed the ability of the STOP-Bang questionnaire and additional variables to effectively predict outcomes such as 30-day readmission, 30-day emergency department (ED) visit, and 30-day reoperation. The C-statistic was used to represent the receiver operating characteristic (ROC) curve, which analyzes the discrimination of a variable or model. RESULTS Included in the sample were all admissions for supratentorial neoplasms treated with craniotomy (352 patients), 49.72% (n = 175) of which were female. The average STOP-Bang score was 1.91 ± 1.22 (range 0-7). A 1-unit higher STOP-Bang score accurately predicted 30-day readmissions (OR 1.31, p = 0.017) and 30-day ED visits (OR 1.36, p = 0.016) with fair accuracy as confirmed by the ROC curve (C-statistic 0.60-0.61). The STOP-Bang questionnaire did not correlate with 30-day reoperation (p = 0.805) or home discharge (p = 0.315). CONCLUSIONS The results of this study suggest that undiagnosed OSA, as assessed via the STOP-Bang questionnaire, is a significant predictor of patient health status and readmission risk in the brain tumor craniotomy population. Further investigations should be undertaken to apply this prediction tool in order to enhance postoperative patient care to reduce the need for unplanned readmissions.
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Affiliation(s)
- Ian F Caplan
- 1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and
| | - Gregory Glauser
- 1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and
| | - Stephen Goodrich
- 1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and
- 2West Chester Statistics Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - H Isaac Chen
- 1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and
| | - Timothy H Lucas
- 1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and
| | - John Y K Lee
- 1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and
| | - Scott D McClintock
- 2West Chester Statistics Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Neil R Malhotra
- 1Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia; and
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Wu H, Zhou JR. [Predictive value of STOP-Bang questionnaire combined with Epworth sleepiness scale for OSA]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 33:319-321. [PMID: 30970401 DOI: 10.13201/j.issn.1001-1781.2019.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Indexed: 06/09/2023]
Abstract
Objective:To explore the predictive value of STOP-Bang questionnaire(SBQ) combined with Epworth sleepiness scale(ESS) for OSA. Method: Both SBQ and ESS were conducted to assess 356 potential OSA patients. ROC curve was drawn in comparison with the gold standard of PSG. The values were obtained after the sensitivity, specificity, positive predictive values and negative predictive values were calculated. Result:When combined, the sensitivity(89.31%), specificity(78.95%), positive predictive value(97.26%), negative predictive value(46.88%) and the area under ROC curve(AUC=0.821) were higher. Conclusion:SBQ and ESS have certain predictive value in OSA screening. When combined, the accuracy of prediction OSA can be improved, which can help medical staff to identify patients with high risk of OSA early.
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Affiliation(s)
- H Wu
- College of Nursing, Chongqing Medical University, Chongqing, 400016, China
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Wortham TC, Rice AN, Gupta DK, Goode V. Implementation of an Obstructive Sleep Apnea Protocol in the Postanesthesia Care Unit for Patients Undergoing Spinal Fusion Surgery. J Perianesth Nurs 2019; 34:739-748. [PMID: 30827791 DOI: 10.1016/j.jopan.2018.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this project was to implement and evaluate the effectiveness of a postanesthesia care unit (PACU) obstructive sleep apnea (OSA) protocol in patients undergoing spinal fusion surgery. DESIGN The structure of this project was a preimplementation and postimplementation design. METHODS A convenience sample of 63 patients admitted to the PACU after spinal fusion surgery, with diagnosed or high-risk OSA, was included in protocol implementation. FINDINGS The prevalence of diagnosed and high-risk OSA at the project implementation site totaled 74% in the spinal fusion population. The incidence of oxygen desaturations was 41% in the preimplementation group and 35% in the postimplementation group. The PACU to intensive care unit transfers were 10% in the preimplementation group and 3% in the postimplementation group. CONCLUSIONS Protocols for surgical patients with OSA require further examination but may function as a guide for postoperative nursing care.
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Jorge C, Benítez I, Torres G, Dakterzada F, Minguez O, Huerto R, Pujol M, Carnes A, Gaeta AM, Dalmases M, Gibert A, Sanchez de la Torres M, Barbé F, Piñol-Ripoll G. The STOP-Bang and Berlin questionnaires to identify obstructive sleep apnoea in Alzheimer's disease patients. Sleep Med 2019; 57:15-20. [PMID: 30897451 DOI: 10.1016/j.sleep.2019.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND A close relationship between obstructive sleep apnoea (OSA) and Alzheimer's disease (AD) has been described in recent years. OSA is a risk factor for AD, but the diagnosis and clinical characteristics of OSA in patients with AD is not well understood. This study evaluated the clinical utility of two screening questionnaires, the STOP-Bang questionnaire (SBQ) and the Berlin questionnaire (BQ), to identify which patients with mild AD are at higher risk of having OSA and to determine the clinical predictors of OSA in this population. METHODS In this study, 91 consecutive outpatients with mild AD were prospectively evaluated with the SBQ and the BQ. All patients underwent level 1 in-laboratory polysomnography. The predictive performance of the questionnaires were calculated for different apnoea-hypopnoea index (AHI) cut-offs. RESULTS The median age of the patients was 76.0 (73.0; 80.0) years, and 58 (63.7%) were female. Of those, 81 patients (89.02%) were found to have OSA defined by an AHI > 5 events/h. Comparing the predictive performances of the SBQ and the BQ, the SBQ was found to have a higher diagnostic sensitivity (85% vs 4%), a lower specificity (35% vs. 96%), a higher positive predictive value (PPV) (44% vs 33%) and negative predictive value (NPV) (80% vs 65%) for detecting severe OSA at an AHI cut-off of 30 events/h. None of the items alone in the two questionnaires predicted the risk of OSA. A modified version of the SBQ, with new cut-off points for several variables according to the characteristics of AD patients, showed a slightly greater AUC than the standard SBQ (AUC 0.61 vs 0.72). CONCLUSION There is a high prevalence of OSA among patients with mild AD. The SBQ and the BQ are not good screening tools for detecting OSA in patients with AD. A modified version of SBQ could increase the detection of these patients.
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Affiliation(s)
- Carme Jorge
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain
| | - Ivan Benítez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gerard Torres
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Faride Dakterzada
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain
| | - Olga Minguez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Raquel Huerto
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain
| | - Montse Pujol
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Anna Carnes
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain
| | - Anna Michela Gaeta
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Mireia Dalmases
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Aurora Gibert
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain
| | - Manuel Sanchez de la Torres
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain.
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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: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Background Diagnosis of sleep-disordered breathing (SDB) requires overnight polysomnography (PSG). Because of the cost and low availability of these procedures, the NoSAS score was developed to identify subjects at high risk of SDB. To evaluate the clinical utility of the NoSAS score for screening patients with SDB in China and to compare the predictive value of the NoSAS score with the Epworth Sleepiness Scale (ESS), we used the STOP-Bang questionnaire and the Berlin questionnaire. Methods In our study, we retrospectively reviewed the existing clinical data of patients who underwent an overnight PSG for suspected SDB from June 2014 to September 2017 at the sleep medical center of Guangdong Medical University Affiliated Second Hospital. The information we collected included all parts of the NoSAS score, the ESS, the STOP-Bang questionnaire and the Berlin questionnaire. Based on the severity of SDB determined by the apnea-hypopnea index (AHI), the patients were classified into four groups of primary snoring (<5 events/h), mild SBD (AHI ≥5 and <15 events/h), moderate SBD (AHI ≥15 and ≤30 events/h) and severe SBD (>30 events/h). We calculated the sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic curve of the five questionnaires to compare their relative efficacy for screening SDB. Results A total of 479 consecutive patients (374 males and 105 females) ranging in age from 18 to 80 years old (mean ± SD, 48.9±14.4 years old) were recruited into this study. When using the standard of AHI ≥5 for diagnosing SDB, the NoSAS score had the largest area under the curve (AUC) (AUC =0.734), and the Berlin questionnaire (AUC =0.732) came second. Both exhibited a better predictive value than the ESS score and the STOP-Bang questionnaire. Using NoSAS ≥8 to predict AHI ≥5 events/h, AHI ≥15 events/h and AHI >30 events/h, the sensitivity and specificity were 0.590 and 0.707, 0.649 and 0.626, and 0.644 and 0.562, respectively; for the STOP-Bang questionnaire, the values were 0.721 and 0.512, 0.752 and 0.440, and 0.763 and 0.399, respectively; and for the Berlin questionnaire, the values were 0.721 and 0.512, 0.752 and 0.440, and 0.763 and 0.399, respectively. Conclusions The NoSAS score and the Berlin questionnaire both exhibited good predictive value for SDB patients. NoSAS is a more suitable questionnaire to use in clinic for the conveniences but the similar performance with another questionnaire.
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Affiliation(s)
- Min Peng
- Department of Respiration, the Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Riken Chen
- Department of Respiration, the Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Junfen Cheng
- Department of Respiration, the Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Jieying Li
- State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wang Liu
- Department of Respiration, the Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, China
| | - Cheng Hong
- State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
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Mason M, Hernández-Sánchez J, Vuylsteke A, Smith I. Usefulness of the STOP-Bang Questionnaire in a Cardiac Surgical Population. J Cardiothorac Vasc Anesth 2018; 32:2694-2699. [PMID: 29934208 DOI: 10.1053/j.jvca.2018.04.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to assess the predictive accuracy of the STOP-Bang questionnaire in relation to obstructive sleep apnea (OSA) detected by nocturnal oximetry, as well as postoperative outcomes, in a population undergoing cardiac surgery. DESIGN A prospective observational cohort study. SETTING The specialist cardiothoracic center at the Royal Papworth Hospital, Cambridge University Health Partners, United Kingdom. PARTICIPANTS All adult patients, undergoing elective coronary artery bypass grafting with or without cardiac valve surgery between March 2013 and July 2014 were included. The authors excluded patients participating in other interventional studies, those who had a tracheostomy before surgery, and those who required emergency surgery or were due to be admitted on the day of surgery. INTERVENTIONS None. MEASUREMENTS AND RESULTS Cardiac surgical patients were screened for the risk of OSA with the use of STOP-Bang questionnaire. The presence of OSA prior to surgery was assessed with overnight oximetry. The predictive performance of the STOP-Bang questionnaire was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC)-receiver operating characteristic curve (ROC). Multiple-logistic regression models were used to assess for associations between the STOP-Bang scores and postoperative outcomes. The STOP-Bang questionnaire discriminated poorly between mild OSA (AUC-ROC 0.57 [95% confidence interval (CI) 0.47-0.67]) and moderate/severe OSA (AUC-ROC 0.82 (95% CI 0.69-0.95)]. Accuracy was increased by modifying the cut-off value to 6 or greater, with sensitivity and specificity of 75% and 77%, respectively. A STOP-Bang score indicating the possibility of OSA was not significantly associated with prolonged intensive care unit lengths of stay (hazard ratio [HR] 1.1; 95% CI 0.99-1.19; p = 0.08) or postoperative complications (odds ratio [OR] 1.0; 95% CI 0.59-1.72; p = 0.98). CONCLUSIONS In the study population, a STOP-Bang questionnaire score of 3 or greater had limited predictive value for identifying cardiac surgical patients at high risk of OSA. STOP-Bang scores were not significantly associated with worse postoperative outcomes. A STOP-Bang score of 6 or greater could help identify patients in need of a sleep study to confirm the presence of OSA as such patients may be at increased risk of postoperative complications.
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Affiliation(s)
- Martina Mason
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
| | | | | | - Ian Smith
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Bazemore KE, Barker M, Morgan BT, Goode V. Utilization of the STOP-Bang Questionnaire as a Standardized Screening Tool for Obstructive Sleep Apnea in Veteran Administration Surgical Patients. J Perianesth Nurs 2018; 34:60-65. [PMID: 29685727 DOI: 10.1016/j.jopan.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) affects an estimated 20% of the adult surgical population. Veteran patients have many characteristics consistent with OSA, but lack of standardized screening results in decreased detection of patients at risk for OSA. DESIGN Pre-post implementation design. METHODS Preanesthesia clinic providers were educated about OSA and the STOP-Bang questionnaire. Chart reviews evaluating screening and patient demographics were conducted before and after intervention. FINDINGS Thirty-one percent of patients had an established diagnosis of OSA. Compliance rates with preoperative STOP-Bang screening were 91.3%. Of patients screened preoperatively, 44% were at risk for OSA with a STOP-Bang score of 4 or greater. CONCLUSIONS The prevalence of patients among the Veteran population with and at risk for OSA is higher than the general population. Utilization of the STOP-Bang questionnaire as a standardized preoperative screening tool in preanesthesia clinics can increase the identification of patients at risk for OSA.
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Teng Y, Wang S, Wang N, Muhuyati. STOP-Bang questionnaire screening for obstructive sleep apnea among Chinese patients with type 2 diabetes mellitus. Arch Med Sci 2018; 14:971-8. [PMID: 30154877 DOI: 10.5114/aoms.2018.73984] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Xia M, Liu S, Ji N, Xu J, Zhou Z, Tong J, Zhang Y. BMI 35 kg/m 2 does not fit everyone: a modified STOP-Bang questionnaire for sleep apnea screening in the Chinese population. Sleep Breath 2018; 22:1075-1082. [PMID: 29322383 DOI: 10.1007/s11325-017-1610-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/30/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The STOP-Bang questionnaire is the most widely used to detect surgical patients at high risk of obstructive sleep apnea (OSA). However, the body mass index (BMI) cutoff value in the original STOP-Bang questionnaire is 35 kg/m2; the BMI in the Chinese population is lower than that. We aimed to establish a more appropriate BMI cutoff value in the STOP-Bang questionnaire for Chinese patients. METHODS A total of 790 consecutive patients scheduled to undergo surgery at our hospital were included in this prospective study. All patients were asked to complete the STOP-Bang questionnaire and undergo a 7-h overnight polysomnography (PSG). The ability of STOP-Bang questionnaire to detect moderate to severe OSA (AHI ≥ 15 events/h) was assessed. RESULTS When the BMI cutoff value was set at 28 kg/m2, the questionnaire had the highest Youden index, although no significant differences were found in the sensitivity of the test compared with the original BMI cutoff in total and in male patients. In females, changing the BMI cutoff value from 35 to 28 kg/m2 resulted in the sensitivity of the test significantly increasing from 79.2% (74.9-83.5) to 89.3% (84.4-94.1), while the decrease in specificity was minor (from 43.6% [41.2-46.0] to 38.2% [36.1-40.3]), and the Youden index was highest (0.27) at this cutoff value. When the STOP-Bang questionnaire score was 4, the highest Youden index was obtained. CONCLUSIONS We recommend using a BMI cutoff value (28 kg/m2), and a STOP-Bang score ≥ 4 allows the anesthetist to identify patients with high risk of OSA.
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Affiliation(s)
- Ming Xia
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221002, China.
- Department of Anesthesiology, Affiliated Hospital, Xuzhou Medical University, Xuzhou, China.
| | - Su Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221002, China
- Department of Anesthesiology, Affiliated Hospital, Xuzhou Medical University, Xuzhou, China
| | - Ningning Ji
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221002, China
| | - Jianguo Xu
- Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Zhiqiang Zhou
- Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jianhua Tong
- Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Yongmei Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221002, China
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Rebelo-Marques A, Vicente C, Valentim B, Agostinho M, Pereira R, Teixeira MF, Moita J. STOP-Bang questionnaire: the validation of a Portuguese version as a screening tool for obstructive sleep apnea (OSA) in primary care. Sleep Breath 2017; 22:757-765. [PMID: 29285601 DOI: 10.1007/s11325-017-1608-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The growing number of suspected patients diagnosed with obstructive sleep apnea (OSA) that are observed in sleep units has increased in the last decade. Therefore, screening methods have become important, especially in primary care (PC). AIM This work aimed to test the performance of the STOP-Bang questionnaire for the suspicion/diagnosis of obstructive sleep apnea. METHODS Eight-month prospective study; all patients referred from PC to the respective sleep clinic accompanied by a completed and translated version of the STOP-Bang questionnaire for a clinical evaluation. RESULTS Two hundred fifty-nine observed patients were the study object. The age was 55.14 ± 12.07 years, 71.03% were male patients with a neck circumference of 40.97 ± 3.07 cm and BMI of 31.1 ± 5.14 kg/m2. The diagnosis was confirmed in 82.6% of the patients: 34.6% having moderate and 36.8% severe disease. A STOP-Bang score of 3 or more resulted in positive predictive value (PPV) of 88.4% and a sensitivity for OSA of 98.6%. Has the questionnaire score raises, OSA's probability also raises in a proportional basis. For a STOP-Bang score of 6, the OSA probability reaches 98% and for a score of 8, it reaches 80% for severe OSA. Lower scores, 3 or 2, had a negative predictive value (NPV) for moderate-to-severe OSA of 86.96 and 87.5%, respectively. CONCLUSION As much as we know, our study is the first that applied the STOP-Bang questionnaire in Portuguese PC. We demonstrate that these is a useful tool for the stratification of patients with suspicion and diagnosis of OSA, showing a high sensitivity and PPV. Besides that, the probability of severe OSA steadily increases along with its score and we show an excellent NPV with lower scores.
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Affiliation(s)
- Alexandre Rebelo-Marques
- USF Condeixa, ACeS Baixo Mondego, ARS Centro, Coimbra, Portugal. .,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Cláudia Vicente
- UCSP Mealhada, ACeS Baixo Mondego, ARS Centro, Coimbra, Portugal
| | - Bruno Valentim
- USF Condeixa, ACeS Baixo Mondego, ARS Centro, Coimbra, Portugal
| | - Marcos Agostinho
- USF Santa Cruz, ACeS Oeste Sul, ARS Lisboa e Vale do Tejo, Lisbon, Portugal
| | - Rosália Pereira
- USF Condeixa, ACeS Baixo Mondego, ARS Centro, Coimbra, Portugal
| | | | - Joaquim Moita
- Sleep Medicine Centre, Coimbra Hospital and University Center, Coimbra, Portugal
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Westlake K, Plihalova A, Pretl M, Lattova Z, Polak J. Screening for obstructive sleep apnea syndrome in patients with type 2 diabetes mellitus: a prospective study on sensitivity of Berlin and STOP-Bang questionnaires. Sleep Med 2016; 26:71-76. [PMID: 27613528 DOI: 10.1016/j.sleep.2016.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/06/2016] [Accepted: 07/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is highly prevalent in patients with Type 2 diabetes mellitus representing an additional risk factor for already increased cardiovascular mortality. As cardiovascular diseases are the main cause of death in this population, there is a need to identify patients with moderate to severe OSA indicated for treatment. We aimed to evaluate the performance of the Berlin, STOP, and STOP-Bang screening questionnaires in a population of patients with Type 2 diabetes mellitus. METHODS 294 consecutive patients with Type 2 diabetes mellitus filled in the questionnaires and underwent overnight home sleep monitoring using a type IV sleep monitor. RESULTS Severe, moderate, and mild OSA was found in 31 (10%), 61 (21%), and 121 (41%) patients, respectively. The questionnaires showed a similar sensitivity and specificity for AHI ≥ 15: 0.69 and 0.50 for Berlin, 0.65 and 0.49 for STOP, and 0.59 and 0.68 for STOP-Bang. However, the performance of the STOP-Bang questionnaire was different in men vs. women, sensitivity being 0.74 vs. 0.29 (p < 0.05) and specificity 0.56 vs. 0.82 (p < 0.05). CONCLUSIONS Even the best-performing Berlin questionnaire failed to identify 31% of patients with moderate to severe OSA as being at high risk of OSA, thus preventing them from receiving a correct diagnosis and treatment. Considering that patients with Type 2 diabetes mellitus are at high risk of cardiovascular mortality and also have a high prevalence of moderate to severe OSA, we find screening based on the questionnaires suboptimal and suggest that OSA screening should be performed using home sleep monitoring devices.
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Affiliation(s)
- Katerina Westlake
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Diabetology Practice Diainmed s.r.o., Slunecna 2, Prague, Czech Republic
| | - Andrea Plihalova
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, Czech Republic
| | - Martin Pretl
- Neurology and Sleep Laboratory, INSPAMED s.r.o., Kubelikova 46, Prague, Czech Republic
| | - Zuzana Lattova
- Sleep Medicine Department, National Institute of Mental Health, Topolová 748, Klecany, Czech Republic
| | - Jan Polak
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, Czech Republic.
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Evans RE, Zimmerman J, Shishido S, Heath E, Bledsoe A, Johnson K. Abbreviated right-sided heart echocardiogram and the STOP-Bang questionnaire-a useful relationship for preoperative patient evaluation? J Clin Anesth 2015; 30:90-8. [PMID: 26547116 DOI: 10.1016/j.jclinane.2015.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 07/28/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE The aims of this study were to (1) explore the incidence of right-sided heart dysfunction (RHD) and STOP-Bang questionnaire responses consistent with obstructive sleep apnea (OSA) and (2) assess the relationship between patients with STOP-Bang questionnaire responses consistent with OSA and echocardiographic findings suggestive of RHD. DESIGN Observational study. SETTING Tertiary academic center preoperative clinic. PATIENTS Two hundred patients presenting for elective surgery to the University of Utah preoperative clinic. INTERVENTION Abbreviated transthoracic right-sided echocardiogram and STOP-Bang questionnaire. MEASUREMENTS Tricuspid annular plane systolic excursion, tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), and the tricuspid inflow E wave to tricuspid annular tissue Doppler e' wave ratio (E/e') for the presence of RHD, as well as responses to STOP-Bang questionnaire. MAIN RESULTS A total of 140 echocardiograms were analyzed after exclusion of participants with incomplete STOP-Bang questionnaires and inadequate images. Thirty-five patients (25%) reported 5 or more positive responses to the STOP-Bang questionnaire. Forty-six patients (35%) had abnormal right-sided heart measurements. Of the 35 patients with STOP-Bang scores 5 or greater, 11 (31%) had evidence of RHD. No correlation was observed between STOP-Bang scores and the echocardiography metrics of RHD. CONCLUSIONS This preliminary study suggests that there are numerous sources of RHD, among one of which is sleep apnea, and/or the STOP-Bang questionnaire is not a sensitive tool for predicting RHD. We conclude that although the STOP-Bang questionnaire is easy to implement in a preoperative clinical setting, it is not useful in identifying patients at risk for RHD.
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Affiliation(s)
- Rebecca E Evans
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756, USA.
| | - Joshua Zimmerman
- Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA.
| | - Sonia Shishido
- Bend Anesthesiology Group, 2500 NE Neff Rd, Bend, OR 97701, USA.
| | - Elise Heath
- Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA.
| | - Amber Bledsoe
- Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA.
| | - Ken Johnson
- Department of Anesthesiology, University of Utah, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132, USA.
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BaHammam AS, Al-Aqeel AM, Alhedyani AA, Al-Obaid GI, Al-Owais MM, Olaish AH. The Validity and Reliability of an Arabic Version of the STOP-Bang Questionnaire for Identifying Obstructive Sleep Apnea. Open Respir Med J 2015; 9:22-9. [PMID: 25834656 PMCID: PMC4378065 DOI: 10.2174/1874306401509010022] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 01/04/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA) is a common, serious, under-recognized and under-diagnosed medical disorder. Polysomnography (PSG) is the gold standard diagnostic test for OSA; however, the cost of testing and the shortage of sleep disorders laboratories limit access to this tool. Therefore, there is a need for a simple and reliable diagnostic tool to screen patients at risk of OSA. Objective: This study was conducted to evaluate the validity and reliability of an Arabic version of the STOP-Bang questionnaire (SBQ) as a screening tool for OSA. Methods: This study was conducted in three steps, as follows: Step 1: the SBQ was translated from English to Arabic (examining both forward and backward translations); Step 2: the test-retest reliability of the questionnaire was investigated; and Step 3: the questionnaire was validated against PSG data prospectively on 100 patients attending a sleep disorders clinic who were subjected to a full-night PSG study after completing the translated version of the SBQ. The validity of the test was tested against the apnea-hypopnea index (AHI). Results: The study group had a mean age of 46.6 ± 14.0 years and a mean AHI of 50.0 ± 37.0/hour. The study demonstrated a high degree of internal consistency and stability over time for the translated SBQ. The Cronbach’s alpha coefficient for the 8-item tool was 0.7. Validation of the SBQ against the AHI at a cut-off of 5 revealed a sensitivity of 98% and positive and negative predictive values of 86% and 67%, respectively. Conclusion: The Arabic version of the SBQ is an easy-to-administer, simple, reliable and valid tool for the identification of OSA in the sleep disorders clinic setting.
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Affiliation(s)
- Ahmed S BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, and National Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia
| | - Alaa M Al-Aqeel
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, and National Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia
| | - Alanoud A Alhedyani
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, and National Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia
| | - Ghaida I Al-Obaid
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, and National Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia
| | - Mashail M Al-Owais
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, and National Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia
| | - Awad H Olaish
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, and National Plan for Science and Technology, King Saud University, Riyadh, Saudi Arabia
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Reis R, Teixeira F, Martins V, Sousa L, Batata L, Santos C, Moutinho J. Validation of a Portuguese version of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea: Analysis in a sleep clinic. Rev Port Pneumol (2006) 2015; 21:61-8. [PMID: 25926368 DOI: 10.1016/j.rppnen.2014.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/20/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Screening methods have become increasingly important owing to the growing number of patients suspected of obstructive sleep apnea (OSA) being referred for sleep consultation. The STOP-Bang questionnaire has been validated as a screening tool for OSA in surgical patients. OBJECTIVES To evaluate the performance of a Portuguese version of the STOP-Bang questionnaire for the diagnosis of OSA in a sleep clinic. METHODS Prospectively, for 2 months, all patients referred to our clinic for clinical evaluation completed a translated version of the STOP-Bang questionnaire in Portuguese and underwent a sleep study. RESULTS We observed 216 patients and 215 (99.5%) were included. Age was 53.63±13.10 years, 63.3% were male patients, neck circumference was 40.4±44.11 cm and BMI was 29.41 [26.85; 33.06] kg/m(2). OSA was present in 78% of the patients, of whom, 33% had moderate and 37% had severe OSA. A STOP-Bang score ≥3 had a sensitivity and positive predictive value (PPV) for OSA of 93.4% and 86.6%, respectively. Each increase in the STOP-Bang score was associated with an increase in the probability of OSA and severe OSA; reaching a 95% OSA probability, for a score of 6, and a 73% severe OSA probability, for a score of 8. A score of 3 and 2 had a negative predictive value for moderate/severe OSA of 85.3% and 91.7%, respectively. CONCLUSIONS The STOP-Bang questionnaire showed high sensitivity and PPV for OSA with the probability of severe OSA steadily increasing, the higher the scores. Furthermore, a low score showed high predictive value for the exclusion of moderate/severe OSA. The STOP-Bang questionnaire can be a powerful tool for stratifying patients in the diagnosis of OSA.
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Affiliation(s)
- R Reis
- Respiratory Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal.
| | - F Teixeira
- Sleep Medicine Center, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - V Martins
- Sleep Medicine Center, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - L Sousa
- Sleep Medicine Center, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - L Batata
- Sleep Medicine Center, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - C Santos
- Sleep Medicine Center, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - J Moutinho
- Sleep Medicine Center, Centro Hospitalar e Universitário de Coimbra, Portugal
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Abstract
Surgical patients with known or unknown obstructive sleep apnea are at increased risk for postoperative complications. By implementing evidence-based practices and a validated screening tool, the postoperative surgical patients at the authors' hospital have a decreased risk of postoperative complications, specifically oversedation. This article discusses the pathophysiology, prevalence, risk factors, care of the postsurgical patient, and use of the validated STOP-Bang questionnaire with obstructive sleep apnea as the focus.
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Affiliation(s)
- Amy Veenstra
- Nursing Administration, Baylor University Medical Center at Dallas, 3500 Gaston Avenue, Dallas, TX 75246, USA.
| | - Emylene Untalan
- Post Anesthesia Care Unit, Baylor University Medical Center at Dallas, 3500 Gaston Avenue, Dallas, TX 75246, USA
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Silva GE, Vana KD, Goodwin JL, Sherrill DL, Quan SF. Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth Sleepiness Scales. J Clin Sleep Med 2012; 7:467-72. [PMID: 22003341 DOI: 10.5664/jcsm.1308] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE The Epworth Sleepiness Scale (ESS) has been used to detect patients with potential sleep disordered breathing (SDB). Recently, a 4-Variable screening tool was proposed to identify patients with SDB, in addition to the STOP and STOP-Bang questionnaires. This study evaluated the abilities of the 4-Variable screening tool, STOP, STOP-Bang, and ESS questionnaires in identifying subjects at risk for SDB. METHODS A total of 4,770 participants who completed polysomnograms in the baseline evaluation of the Sleep Heart Health Study (SHHS) were included. Subjects with RDIs ≥ 15 and ≥ 30 were considered to have moderate-to-severe or severe SDB, respectively. Variables were constructed to approximate those in the questionnaires. The risk of SDB was calculated by the 4-Variable screening tool according to Takegami et al. The STOP and STOP-Bang questionnaires were evaluated including variables for snoring, tiredness/sleepiness, observed apnea, blood pressure, body mass index, age, neck circumference, and gender. Sleepiness was evaluated using the ESS questionnaire and scores were dichotomized into < 11 and ≥ 11. RESULTS The STOP-Bang questionnaire had higher sensitivity to predict moderate-to-severe (87.0%) and severe (70.4%) SDB, while the 4-Variable screening tool had higher specificity to predict moderate-to-severe and severe SDB (93.2% for both). CONCLUSIONS In community populations such as the SHHS, high specificities may be more useful in excluding low-risk patients, while avoiding false positives. However, sleep clinicians may prefer to use screening tools with high sensitivities, like the STOP-Bang, in order to avoid missing cases that may lead to adverse health consequences and increased healthcare costs.
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Affiliation(s)
- Graciela E Silva
- College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ 85004-0698, USA.
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