Usefulness of self-administered questionnaires in screening for direct referral for polysomnography without sleep physician review.

Abstract

To evaluate self-administered screening questionnaires (Epworth Sleepiness Scale [ESS], Berlin, OSA50, and STOP-Bang questionnaires) in patients considered for polysomnography for probable obstructive sleep apnea suitable for direct polysomnography without sleep specialist review and to evaluate the usefulness of combining questionnaires in this population. This was a retrospective review of tertiary sleep center referrals (November 2017 to April 2020) where ≥ 3 screening questionnaires were completed and type 1 polysomnography was performed. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios to detect an apnea-hypopnea index (AHI) ≥ 15 or ≥ 30 events/h were calculated for each questionnaire (with or without ESS ≥ 8) or any positive questionnaire with ESS ≥ 8. We included 2,152 patients. The questionnaires were completed in the majority (ESS 96%, Berlin 77%, OSA50 84%, and STOP-Bang 90%) of referrals. Berlin was most sensitive (82.5% and 85% to detect AHI ≥ 15 and ≥ 30 events/h, respectively) but least specific (23% both thresholds). STOP-Bang was least sensitive (66% and 42%, respectively) but most specific (68% and 60%, respectively). Sensitivity declined for the Berlin, OSA50 and STOP-Bang questionnaires when combined with ESS ≥ 8. Combining any questionnaire with ESS ≥ 8 returned an intermediate sensitivity of 61% and 73% and a specificity of 49% and 47% for AHI ≥ 15 and ≥ 30 events/h, respectively. STOP-Bang alone was predictive of obstructive sleep apnea on multivariate analysis but was only associated with a clinically nonsignificant positive likelihood ratio. However, STOP-Bang is associated with unacceptable false-positive and -negative rates, which did not support its use. Self-administered questionnaires are inadequate in patients under consideration for polysomnography and should not be used as clinical support for suitability of direct polysomnography without sleep specialist review. Combining questionnaires causes deteriorated performance. Hukins C, Duce B. Usefulness of self-administered questionnaires in screening for direct referral for polysomnography without sleep physician review. J Clin Sleep Med. 2022;18(5):1405-1412.