Screening Questionnaires For Obstructive Sleep Apnea Research Articles

Crossectional Study on the Performance of Screening Questionnaires for Prediction of Moderate to Severe Obstructive Sleep Apnea in Women

Abstract Introduction The clinical manifestations of obstructive sleep apnea (OSA) are different between genders. Though there are several screening questionnaires for OSA, their performance in females is not fully understood, as women have been historically underrepresented in research studies. Objective To assess the performance of screening questionnaires and their capacity to identify a moderate to severe apnea-hypopnea index (AHI) in women. Materials and Methods The Epworth sleep scale (ESS), Berlin questionnaire, and STOP-BANG questionnaire (SBQ) were correlated with AHI. Also, the sensitivity (S), specificity (Sp), and area under the receiver operating characteristic (AUC-ROC) curve were calculated for each questionnaire and combinations thereof. Multiple regression models were used to identify ≥15 ev/h AHI. Results Our study included 5,344 patients: 1978 women (37.1%) aged 55.06 ± 14 years with body mass index (BMI): 32.6 ± 8.30 kg/m2, ESS: 7.69 ± 5.2 points, and high-risk Berlin score: 87.25%. An AHI ≥15 ev/h was found in 30.4% of women. In terms of the capacity to identify an ≥15 ev/h AHI in women, the AUC-ROC of ESS >10 and high-risk Berlin was 0.53 and 0.58, respectively. Three components of SBQ in any combination showed: a S of 65.1% (95% CI: 61.2–68.9), a Sp: 61.5% (95% CI: 58.9–64.1), with the AUC-ROC: 0.67. Conclusions Questionnaires perform differently in women. Therefore, it is necessary to take a gender-specific approach. The SBQ showed a higher discriminative power and more specificity than the ESS and the Berlin questionnaire. The best performance was obtained with any combination of 3 SBQ components. Age, BMI, neck circumference, and hypertension were the strongest predictors.

Symptom content analysis of OSA questionnaires: time to identify and improve relevance of diversity of OSA symptoms?

Obstructive sleep apnea (OSA) is a heterogeneous condition covering many clinical phenotypes in terms of the diversity of symptoms. Patient-based OSA screening questionnaires used in routine practice contain significantly varying contents that can impact the reliability and validity of the screening. We investigated to what extent common patient-based OSA screening questionnaires differ or overlap in their item content by conducting a rigorous, methodical, and quantified content overlap analysis. We conducted an item content analysis of 11 OSA screening questionnaires validated in adult populations and characterized their overlap using a four-step approach: i) selection of OSA screening questionnaires; ii) item extraction and selection; iii) extraction of symptoms from items; iv) assessment of content overlap with the Jaccard Index (from 0: no overlap to 1: full overlap). We extracted 72 items that provided 25 distinct symptoms from 11 selected OSA questionnaires. The overlap between them was weak (mean Jaccard Index 0.224, ranging from 0.138 to 0.329). All questionnaires contained symptoms of the "OSA symptom" dimension (e.g., snoring or witnessed apneas). The STOP-BANG (0.329) and the Berlin (0.280) questionnaires exhibited the highest overlap content. Ten symptoms (40%) were investigated in only one questionnaire. The heterogeneity of content and the low overlap across these questionnaires reflect the challenges of screening OSA. The different OSA questionnaires potentially capture varying aspects of the disorder, with the risk of biased results in studies. Suggestions are made for better OSA screening and refinement of clinical OSA phenotypes.

Predicting obstructive sleep apnea severity from craniofacial images using ensemble machine learning models.

Obstructive sleep apnea (OSA) is a prevalent disease affecting 10 to 15% of Americans and nearly one billion people worldwide. It leads to multiple symptoms including daytime sleepiness; snoring, choking, or gasping during sleep; fatigue; headaches; non-restorative sleep; and insomnia due to frequent arousals. Although polysomnography (PSG) is the gold standard for OSA diagnosis, it is expensive, not universally available, and time-consuming, so many patients go undiagnosed due to lack of access to the test. Given the incomplete access and high cost of PSG, many studies are seeking alternative diagnosis approaches based on different data modalities. Here, we propose a machine learning model to predict OSA severity from 2D frontal view craniofacial images. In a cross-validation study of 280 patients, our method achieves an average AUC of 0.780. In comparison, the craniofacial analysis model proposed by a recent study only achieves 0.638 AUC on our dataset. The proposed model also outperforms the widely used STOP-BANG OSA screening questionnaire, which achieves an AUC of 0.52 on our dataset. Our findings indicate that deep learning has the potential to significantly reduce the cost of OSA diagnosis.

Establishment and Application Evaluation of an Improved Obstructive Sleep Apnea Screening Questionnaire for Chinese Community: The CNCQ-OSA.

Obstructive sleep apnea (OSA) is a common sleep-disordered breathing disease. We aimed to establish an improved screening questionnaire without physical examinations for OSA named the CNCQ-OSA (Chinese community questionnaire for OSA). A total of 2585 participants who visited sleep medicine center and underwent overnight polysomnography were grouped into two independent cohorts: derivation (n = 2180) and validation (n = 405). The CNCQ-OSA was designed according to the baseline of patients in derivation cohort. We comprehensively analyzed the data to evaluate the predictive value of the CNCQ-OSA, compared to the GOAL questionnaire, STOP-Bang questionnaire (SBQ) and NoSAS questionnaire. The CNCQ-OSA included seven variables: loud snoring, BMI ≥ 25 kg/m2, male gender, apnea, sleepiness, hypertension and age ≥30, with a total score ranging from 7 to 16.7 points (≥13.5 points indicating high risk of OSA, ≥14.5 points indicating extremely high risk). In the derivation and validation cohorts, the areas under the curve of the CNCQ-OSA were 0.761 and 0.767, respectively. In the validation cohort, the sensitivity and specificity of a CNCQ-OSA score ≥13.5 points for the apnea-hypopnea index (AHI) ≥5/h were 0.821 and 0.559, respectively (Youden index, 0.380), and the score ≥14.5 points were 0.494 and 0.887, respectively (Youden index, 0.375). The CNCQ-OSA had a better predictive value for AHI ≥ 5/h, AHI > 15/h and AHI > 30/h, with the highest Youden index, compared to the other questionnaires. The CNCQ-OSA can effectively identify the risk of OSA, which is appropriate for self-screening at home without physical examinations.

Obstructive Sleep Apnea Among Gravidas With Chronic Hypertension Compared to Matched Controls: A Prospective Cohort Study.

Previous studies of obstructive sleep apnea (OSA) risk in gravidas with chronic hypertension (cHTN) did not control for obesity as a risk factor for OSA. We therefore performed this study to evaluate whether OSA is more prevalent among gravidas with cHTN compared to normotensive gravidas matched for body mass index (BMI) and gestational age (primary outcome). We also assessed whether OSA is more severe when comorbid with cHTN in pregnancy (secondary outcome). This was a single-center, prospective cohort study. Adult gravidas at 10-20 weeks of gestation, with and without cHTN, were enrolled and BMI matched. All subjects answered OSA screening questionnaires and underwent a home sleep test when they were between 10 and 20 weeks of gestation. Pregnancy outcomes were followed for all subjects. We performed univariable and multivariable logistic regression to model the relationship between cHTN status and OSA. A total of 100 pregnant subjects (50 with cHTN and 50 normotensive) completed a home sleep test of 2 hours or more. There were no differences in demographic variables between the 2 groups, except that gravidas with cHTN were significantly older than normotensive subjects (mean ± standard deviation [SD] 34 ± 4 vs 30 ± 6 years; P < .001). OSA was more prevalent (64% vs 38%; P = .009; odds ratio [95% confidence interval (CI)] 2.90 [1.30-6.65]; P = .01) and more severe in gravidas with cHTN (moderate or severe OSA 59% vs 21%; P = .009). After controlling for age, we found no overall association between cHTN on OSA risk (adjusted odds ratio [95% CI] 2.22 [0.92-5.40]; P = .076). However, among gravidas older than 25 years of age, cHTN was associated with higher odds of OSA (adjusted odds ratio [95% CI], 2.64 [1.06-6.71], P = .038). cHTN and age are important risk factors for OSA in gravidas. Gravidas with cHTN should be screened for OSA in early pregnancy. Future studies may validate screening tools that include cHTN and age, and investigate the role of OSA therapy in blood pressure control.

Does the risk of obstructive sleep apnea (OSA) affect erectile function recovery (EFR) after radical prostatectomy (RP)?

ABSTRACT Introduction Obstructive sleep apnea (OSA) affects as many as 7% of adult men in the general population, higher in men with obesity and large neck sizes. OSA is associated with ED. No data to date has assessed EFR after RP in men with OSA. Objective The objective of this study was to define EFR rates 2 years post-RP. Methods Records of men who underwent RP with 24-month post-RP follow-up were reviewed. ADT and radiation therapy were exclusions. Men completed the OSA screening questionnaire, STOP-BANG (SB) pre-RP. Men were divided into OSA risk groups: high, intermediate, and low. EFR was recorded using IIEF-EFD score, with a score of at least 24 indicating recovery. Univariable and multivariable logistic regression analyses assessed predictors of EFR. Results 454 men were analyzed. Mean age 62 ± 7 years. Of the studied population,12% had a history of OSA,10% had diabetes,12% were current smokers, and 37% were former smokers. The median STOP-BANG (SB) score was 2. High, intermediate, and low risk of OSA scores were 8%, 41% and 51% respectively. Mean baseline testosterone (T) was 495 ng/dL, PSA 7.4 ng/mL, and EFD score 22. Most men had a Gleason sum of 7 (87%). 73% of patients had bilateral or unilateral neurovascular bundle preservation. At the 2-year follow up, median EFD score in high, intermediate and low OSA risk groups: were 9, 16, and 18 respectively. The low OSA risk group was significantly more likely to recover (OR = 1.6, 1.1 – 2.4) than the moderate/high group. Younger age (OR = 0.92, 0.89 – 0.95), absence of diabetes (OR = 0.31, 0.14 – 0.72), higher baseline T (OR per 100 units = 1.40, 1.04 – 1.89), higher baseline EFD score (OR = 1.16, 1.11 – 1.22), and lower Gleason score (OR = 0.53, 0.34 – 0.82) were also associated with recovery at 2 years. Conclusions In our cohort, at 2 years post-RP, increasing OSA risk is associated with poorer EFR in men post-RP. Disclosure Work supported by industry: no.

BASH-GN: a new machine learning-derived questionnaire for screening obstructive sleep apnea.

This study aimed to develop a machine learning-based questionnaire (BASH-GN) to classify obstructive sleep apnea (OSA) risk by considering risk factor subtypes. Participants who met study inclusion criteria were selected from the Sleep Heart Health Study Visit 1 (SHHS 1) database. Other participants from the Wisconsin Sleep Cohort (WSC) served as an independent test dataset. Participants with an apnea hypopnea index (AHI) ≥ 15/h were considered as high risk forOSA. Potential risk factors were ranked using mutual information between each factor and the AHI, and only the top 50% were selected. We classified the subjects into 2 different groups, low and high phenotype groups, according to their risk scores. We then developed the BASH-GN, a machine learning-based questionnaire that consists of two logistic regression classifiers for the 2 different subtypes of OSA risk prediction. We evaluated the BASH-GN on the SHHS 1 test set (n = 1237) and WSC set (n = 1120) and compared its performance with four commonly used OSA screening questionnaires, the Four-Variable, Epworth Sleepiness Scale, Berlin, and STOP-BANG. The model outperformed these questionnaires on both test sets regarding the area under the receiver operating characteristic (AUROC) and the area under the precision-recall curve (AUPRC). The model achieved AUROC (SHHS 1: 0.78, WSC: 0.76) and AUPRC (SHHS 1: 0.72, WSC: 0.74), respectively. The questionnaire is available at https://c2ship.org/bash-gn . Considering OSA subtypes when evaluating OSA risk may improve the accuracy of OSA screening.

Prevalence and Severity of Obstructive Sleep Apnea in Men with Polycythemia on Testosterone Therapy

ABSTRACT Introduction Polycythemia is independently associated with both testosterone therapy (TTH) and obstructive sleep apnea (OSA). Objective The purpose of this study was to evaluate the prevalence and severity of OSA in men who experience polycythemia while on TTH. Methods Study population included men who had polycythemia [hematocrit (HCT) &amp;gt;50%] while on TTH for TD, with total and free T levels within the normal range. Men completed screening questionnaires for OSA and daytime sleepiness, respectively: STOP-BANG (SB, range 0-8) and the Epworth Sleepiness Scale (ESS, range 0-24). Men whose scores demonstrated intermediate to high risk of OSA proceeded to a diagnostic sleep study which recorded the following parameters: apnea hypoxia index (AHI, normal &amp;lt;5 events/h), total duration SpO2 saturation &amp;lt;88% and SpO2 nadir. Descriptive statistics are presented. Results 73 men had a mean age of 60±11.5 years. Mean HCT pre-TTH and on TTH were 45±3% and 52±1.5%, respectively, for a mean increase of 6.6±3.6%. Mean on-treatment total T level 686±285 ng/dL. Median STOP-BANG score was 4 (IQR 3-5), median ESS score was 5 (IQR 3-9). 63% of patients screened positive for OSA on questionnaires. 81% of sleep studies confirmed OSA; mean AHI of the group was 15.4±13.2 events/hour (range 1.6-54.6 events/hour). 36% of men had AHI≥15 events/hour and 14% ≥30 AHI events/hour. Mean SpO2 nadir was 83±5% (range 69%-93%). 67% of men with OSA had an oxygen nadir in the 80s, 19% in the 70s and 3% in the 60s. Total duration of hypoxia (SpO2 ≤88%) was 32±50 minutes (range 0.1-202 minutes), 46% of men having hypoxia &amp;lt;10 minutes, 8% 10-20 minutes, 19% 70-150 minutes. Conclusions Men on TTH who are eugonadal that experience polycythemia have high rates of OSA. 80% of the patients undergoing sleep study had OSA. These data suggest that men with polycythemia on TTH should be screened for OSA. Disclosure No

Does the Risk of Obstructive Sleep Apnea (OSA) Affect Erectile Function Recovery (EFR) After Radical Prostatectomy (RP)?

ABSTRACT Introduction Obstructive sleep apnea (OSA) affects as many as 7% of adult men in the general population, higher in men with obesity and large neck sizes. OSA is associated with ED. No data to date has assessed EFR after RP in men with OSA. Objective The objective of this study was to define EFR rates 2 years post-RP. Methods Records of men who underwent RP with 24-month post-RP follow-up were reviewed. ADT and radiation therapy were exclusions. Men completed the OSA screening questionnaire, STOP-BANG (SB) pre-RP. Men were divided into OSA risk groups: high, intermediate, and low. EFR was recorded using IIEF-EFD score, with a score of at least 24 indicating recovery. Univariable and multivariable logistic regression analyses assessed predictors of EFR. Results 454 men were analyzed. Mean age 62 ± 7 years. Of the studied population,12% had a history of OSA,10% had diabetes,12% were current smokers, and 37% were former smokers. The median STOP-BANG (SB) score was 2. High, intermediate, and low risk of OSA scores were 8%, 41% and 51% respectively. Mean baseline testosterone (T) was 495 ng/dL, PSA 7.4 ng/mL, and EFD score 22. Most men had a Gleason sum of 7 (87%). 73% of patients had bilateral or unilateral neurovascular bundle preservation. At the 2-year follow up, median EFD score in high, intermediate and low OSA risk groups: were 9, 16, and 18 respectively. The low OSA risk group was significantly more likely to recover (OR = 1.6, 1.1 – 2.4) than the moderate/high group. Younger age (OR = 0.92, 0.89 – 0.95), absence of diabetes (OR = 0.31, 0.14 – 0.72), higher baseline T (OR per 100 units = 1.40, 1.04 – 1.89), higher baseline EFD score (OR = 1.16, 1.11 – 1.22), and lower Gleason score (OR = 0.53, 0.34 – 0.82) were also associated with recovery at 2 years. Conclusions In our cohort, at 2 years post-RP, increasing OSA risk is associated with poorer EFR in men post-RP. Disclosure No

Effect of Opium Versus Methadone on Polysomnographic Characteristics of Patients With Obesity Hypoventilation Syndrome

Background There are studies about polysomnographic (PSG) characteristics of patients with either Obesity Hypoventilation Syndrome (OHS) or addiction. We aimed to investigate the PSG characteristics of OHS patients with opium addiction (OA) and those on methadone maintenance treatment (MMT) for treatment of addiction. Methods In this cross-sectional study, we enrolled 75 patients with OHS in Bamdad Respiratory and Sleep Research Center affiliated to Isfahan University of Medical Sciences between January 2020 and February 2021. The patients were categorized in three groups: OA, MMT, and non-addicts (NA). Demographic and PSG characteristics and obstructive sleep apnea screening questionnaires (Epworth Sleepiness scale, Berlin, and STOP-Bang) of patients were recorded and analyzed by SPSS v.24. Results A total of 75 OHS patients [54 men (72%) and 21 women (28%)] were studied in three groups of OA (30), MMT (15), and NA (30). Apnea hypopnea index (AHI) was not significantly different between three groups. The longest apnea duration was higher in OA than other groups (P:0.001). Central apnea index (P: 0.01), longest hypopnea duration(P:0.04), PaCO2(P:0.04) and time with SpO2˂90% (T90) (P: 0.009) were higher in MMT than other groups. Furthermore, the minimum SpO2was lower in MMT than others (P: 0.03). Conclusion The current study demonstrated that some of the sleep disturbances were worse in MMT than OA group. This suggests the need for further studies to compare the effects of opium and methadone on sleep in OHS patients.

Prevalence and predictors of obstructive sleep apnea in snorers without excessive daytime sleepiness

Introduction Obstructive sleep apnea (OSA) can be presented by diverse phenotypes with or without excessive daytime sleepiness (EDS). The present study was conducted to detect the prevalence and the predictors of OSA in a sample of habitual snorers without EDS nor nocturnal observed apnea. Patients and methods A total of 61 adult participants complaining of habitual snoring were included in the study and subjected to OSA screening questionnaire, anthropometric measures, tonsil examination, modified Mallampati score, and full polysomnography. Univariate analysis and regression analysis were done to detect the association of OSA with participants’ characteristics and polysomnography data. The statistically significant variables were entered into the receiver operating characteristic curve to estimate the best cutoff values for predictors of OSA in habitual snorers. Results The studied patients were divided into two groups: 11.5% had no OSA [apnea–hypopnea index (AHI)<5], and 88.5% had OSA. AHI values were significantly greater in males compared with females [45.2 (interquartile range: 29.9–62.6) in males versus 22.1 (interquartile range: 9.6–35.9) in females, P=0.001]. There was a statistically significant positive correlation between AHI and age (r=0.39). The best cutoff point of age to detect OSA group was more than 43 years with a sensitivity of 64.81%, specificity of 100%, and total accuracy of 0.86. The best cutoff point of BMI to detect OSA group was more than 37 kg/m2, with a sensitivity of 46.30%, specificity of 100%, and total accuracy of 0.75. Conclusion OSA should be investigated in habitual snorers even in the absence of EDS and nocturnal apnea, especially in older (>43 years), obese (BMI >37 kg/m2), and male patients.

Obstructive sleep apnea is common in patients with high-impact chronic pain- an exploratory study from an interdisciplinary pain center.

Sleep disturbances are increasingly recognized as a major part of chronic pain pathology. Obstructive sleep apnea (OSA) is a common occurrence in patients with chronic pain attending specialized pain clinics, yet its prevalence remains unclear. Using screening tools such as the Berlin and STOP-BANG questionnaires may aid in early identification of OSA and improve clinical care. This study i) examined the frequency of OSA based on objective sleep monitoring in patients with high-impact chronic pain, ii) explored potential differences in self-reported pain and sleep characteristics between patients with and without OSA, and iii) tested the agreement between OSA classification based on objective assessment and two OSA screening questionnaires. A consecutive cohort of 90 patients (71 women and 19 men; mean age: 47.1±11.0 years) referred for interdisciplinary pain treatment, underwent one night of sleep monitoring using portable respiratory polygraphy (RP), and suspected OSA was confirmed with polysomnography (PSG). Self-reported data on clinical pain (severity, pain drawings and health-related quality of life), sleep characteristics (sleep quality insomnia, sleepiness), and risk of OSA (Berlin and STOP-BANG questionnaires) were collected the day before RP assessment. Forty-six (51.1%) patients were classified with OSA according to RP and verified with PSG. Twenty-eight patients (31.1%) had moderate or severe OSA (apnea-hypopnea index [AHI] >15). Patients with OSA reported lower sleep quality compared with patients without OSA. Scores on pain severity, disability, quality of life, insomnia and sleepiness were comparable between patients with and without OSA. Sensitivity and specificity were 78.6 and 45.2% respectively for the Berlin questionnaire, and 71.4 and 58.1% respectively for the STOP-BANG questionnaire. The agreement for both questionnaires with objective assessment was poor-to-fair. Both questionnaires had acceptable negative predictive values but low positive predictive values reducing the clinical utility to identify patients with low OSA-risk in this sample. The current study demonstrates a high prevalence of OSA in patients with high-impact chronic pain referred to specialized pain treatment, however the clinical pain profiles were similar in patients with and without OSA. The Berlin and STOP-BANG questionnaires have poor specificity and low-to-fair agreement with RP/PSG questioning their clinical utility in identifying OSA in this sample.

MP27-02 DOES THE RISK OF OBSTRUCTIVE SLEEP APNEA (OSA) AFFECT ERECTILE FUNCTION RECOVERY (EFR) AFTER RADICAL PROSTATECTOMY (RP)?

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (MP27)1 Sep 2021MP27-02 DOES THE RISK OF OBSTRUCTIVE SLEEP APNEA (OSA) AFFECT ERECTILE FUNCTION RECOVERY (EFR) AFTER RADICAL PROSTATECTOMY (RP)? Jose M. Flores, Carolyn A. Salter, Karin Ruiz, Nicole Benfante, Elizabeth Schofield, Miranda Tan, Vincent Laudone, and John P. Mulhall Jose M. FloresJose M. Flores More articles by this author , Carolyn A. SalterCarolyn A. Salter More articles by this author , Karin RuizKarin Ruiz More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , Elizabeth SchofieldElizabeth Schofield More articles by this author , Miranda TanMiranda Tan More articles by this author , Vincent LaudoneVincent Laudone More articles by this author , and John P. MulhallJohn P. Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002024.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Obstructive sleep apnea (OSA) affects as many as 7% of adult men in the general population, higher in men with obesity and large neck sizes. OSA is associated with ED. No data to date has assessed EFR after RP in men with OSA. The objective of this study was to define EFR rates 2 years post-RP. METHODS: Records of men who underwent RP with 24-month post-RP follow-up were reviewed. ADT and radiation therapy were exclusions. Men completed the OSA screening questionnaire, STOP-BANG (SB) pre-RP. Men were divided into OSA risk groups: high, intermediate, and low. EFR was recorded using IIEF-EFD score, with a score of at least 24 indicating recovery. Univariable and multivariable logistic regression analyses assessed predictors of EFR. RESULTS: 454 men were analyzed. Mean age 62±7 years. Of the studied population, 12% had a history of OSA, 10% had diabetes, 12% were current smokers, and 37% were former smokers. The median STOP-BANG (SB) score was 2. High, intermediate, and low risk of OSA scores were 8%, 41% and 51% respectively. Mean baseline testosterone (T) was 495 ng/dL, PSA 7.4 ng/mL, and EFD score 22. Most men had a Gleason sum of 7 (87%). 73% of patients had bilateral or unilateral neurovascular bundle preservation. At the 2-year follow up, median EFD score in high, intermediate and low OSA risk groups: were 9, 16, and 18 respectively. The low OSA risk group was significantly more likely to recover (OR = 1.6, 1.1–2.4) than the moderate/high group. Younger age (OR = 0.92, 0.89–0.95), absence of diabetes (OR = 0.31, 0.14–0.72), higher baseline T (OR per 100 units = 1.40, 1.04–1.89), higher baseline EFD score (OR = 1.16, 1.11–1.22), and lower Gleason score (OR = 0.53, 0.34–0.82) were also associated with recovery at 2 years. CONCLUSIONS: In our cohort, at 2 years post-RP, increasing OSA risk is associated with poorer EFR in men post-RP. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e472-e472 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jose M. Flores More articles by this author Carolyn A. Salter More articles by this author Karin Ruiz More articles by this author Nicole Benfante More articles by this author Elizabeth Schofield More articles by this author Miranda Tan More articles by this author Vincent Laudone More articles by this author John P. Mulhall More articles by this author Expand All Advertisement Loading ...

Identifying Predictors of Airway Complications During Conscious Sedation Procedures.

Conscious sedation procedures are complicated by unanticipated airway compromise and obstruction. The STOP-Bang questionnaire (University of Toronto, 2012) is a validated obstructive sleep apnea screening questionnaire used as a preprocedure evaluation tool to assess a patient's risk for obstructive sleep apnea. The purpose of this study was to determine whether risk factors for obstructive sleep apnea, using the STOP-Bang questionnaire, could predict procedural airway complications in 152 endoscopy patients following conscious sedation. Logistic regression analysis revealed that a STOP-Bang score of greater than 5 (high risk) predicted a 10% change in heart rate (p = .021), apnea (p = .038), and arousal-relieved airway obstruction (p = .023). Every point of increase in body mass index predicted a 10% change in heart rate (p = .046), a drop in oxygen saturation (p = .002), apnea (p = .003), and 1.212 times the odds of requiring arousal-relieved airway obstruction (p = .002). An intermediate-risk STOP-Bang score (3-4) positively correlated to abnormal carbon dioxide values during the procedure (p = .015). These findings concur with existing literature on the topic and translate to clinical considerations of procedural monitoring protocols for patients with a high probability for airway complications during conscious sedation.

Prediction Models of Obstructive Sleep Apnea in Pregnancy: A Systematic Review and Meta-Analysis of Model Performance.

Background: Gestational obstructive sleep apnea (OSA) is associated with adverse maternal and fetal outcomes. Timely diagnosis and treatment are crucial to improve pregnancy outcomes. Conventional OSA screening questionnaires are less accurate, and various prediction models have been studied specifically during pregnancy. Methods: A systematic review and meta-analysis were performed for multivariable prediction models of both development and validation involving diagnosis of OSA during pregnancy. Results: Of 1262 articles, only 6 studies (3713 participants) met the inclusion criteria and were included for review. All studies showed high risk of bias for the construct of models. The pooled C-statistics (95%CI) for development prediction models was 0.817 (0.783, 0850), I2 = 97.81 and 0.855 (0.822, 0.887), I2 = 98.06 for the first and second–third trimesters, respectively. Only multivariable apnea prediction (MVAP), and Facco models were externally validated with pooled C-statistics (95%CI) of 0.743 (0.688, 0.798), I2 = 95.84, and 0.791 (0.767, 0.815), I2 = 77.34, respectively. The most common predictors in the models were body mass index, age, and snoring, none included hypersomnolence. Conclusions: Prediction models for gestational OSA showed good performance during early and late trimesters. A high level of heterogeneity and few external validations were found indicating limitation for generalizability and the need for further studies.

Screening for Obstructive Sleep Apnea in an Atrial Fibrillation Population: What’s the Best Test?

BackgroundAmong individuals with nonvalvular atrial fibrillation (AF), the prevalence of obstructive sleep apnea (OSA) can be as high as 85%. Continuous positive airway pressure treatment for moderate or severe OSA might improve AF outcomes and quality of life, so early identification of OSA might be of value. However, screening questionnaires for OSA are suboptimal because they are weighted toward tiredness and loud snoring, which might be absent in AF patients. NoSAS (Neck, Obesity, Snoring, Age, Sex) is a new OSA questionnaire that excludes these parameters. Acoustic pharyngometry (AP) is a potential novel screening technique that measures pharyngeal cross-sectional area, which is reduced in patients with OSA. MethodsWe prospectively compared the accuracy of the NoSAS, the STOP-BANG questionnaire (Snoring, Tiredness, Observed apnea, blood Pressure, Body mass index, Age, Neck circumference and Gender), and AP with home sleep apnea testing (HSAT) in consecutive patients with nonvalvular AF. ResultsOf 188 participants, 86% had OSA and 49% had moderate or severe OSA. Mean Epworth Sleepiness Scale scores were low; 5.9 (SD, 3.9), indicating that most participants were not sleepy. Receiver operating characteristic curves for comparisons of screening tests with HSAT showed suboptimal accuracy. For moderate plus severe and severe only groups respectively, the area under the curve was 0.50 (95% confidence interval [CI], 0.42-0.58) and 0.42 (95% CI, 0.34-0.52) for AP, 0.65 (95% CI, 0.58-0.73) and 0.63 (95% CI, 0.52-0.74) for the STOP-BANG questionnaire, and 0.68 (95% CI, 0.60-0.75) and 0.69 (95% CI, 0.59-0.80) for the NoSAS. ConclusionsAP and NoSAS are not sufficiently accurate for screening AF patients for OSA. Because of the high rates of OSA in this cohort, the potential benefits of OSA treatment, and the suboptimal accuracy of current screening questionnaires, cardiologists should consider HSAT for AF patients.

The role of dry mouth in screening sleep apnea

Purpose of the studyEffective screening questionnaires are essential for early detection of obstructive sleep apnea (OSA). The STOP-Bang questionnaire has high sensitivity but low specificity. Dry mouth is a typical...

Diagnostic paths for a mouth-breathing patient

The clinical choice of diagnostic tests or treatment options is determined by the probability that the value of their execution (called the warrant for the test) exceeds their cost, and by their usefulness. The purpose of this study was to determine the warrant and usefulness of STOP-Bang, an obstructive sleep apnea screening questionnaire, and cone-beam computed tomography (CBCT) information about the minimal cross-sectional area for referring a mouth-breathing patient to a sleep specialist and for modifying planned orthodontic treatment. A branching survey was used to identify the prominence of paths between the presenting situation, 2 diagnostic tests, and 2 referral and/or treatment options. A description was given of a hypothetical patient: an overweight, mouth-breathing female teenager. Path analysis was used as a method for quantifying diagnostic warrant and usefulness. There was a wide variation among the 125 orthodontists who responded to the survey. All paths were chosen. The use of tests altered the referral (χ2=8.039; P=0.03) and/or treatment decisions (χ2=12.636; P=0.005). Ownership of a CBCT system significantly influenced the use of this diagnostic test, with owning a CBCT system resulting in greater use in-office (χ2=50.416; P<0.001) and greater use in the study (χ2=22.959; P<0.001). The usefulness of the diagnostic tests could not be determined directly because common values were used for each test, but the variation in the use of this standard stimulus was very large, indicating personal differences in the interpretation of actual data. Wide variation in the choice and interpretation of diagnostic tests for referral and orthodontic treatment modification relative to airway condition exists among orthodontists. Diagnostic path analysis is a potentially useful model for studying how practitioners make decisions independent of research evidence.

Psychometric Properties and Predictive Value of a Screening Questionnaire for Obstructive Sleep Apnea in Young Children With Down Syndrome.

Study ObjectivesObstructive sleep apnea (OSA) is common in children with Down syndrome (DS) and is associated with adverse health and cognitive outcomes. Daytime clinical assessment is poorly predictive of OSA, so regular screening with sleep studies is recommended. However, sleep studies are costly and not available to all children worldwide. We aimed to evaluate the psychometric properties and predictive value of a newly developed screening questionnaire for OSA in this population.Methods202 children aged 6 months to 6th birthday with DS were recruited, of whom 188 completed cardio-respiratory sleep studies to generate an obstructive apnea hypopnea index (OAHI). Parents completed the 14-item Down syndrome OSA screening questionnaire. Responses were screened, a factor analysis undertaken, internal consistency calculated and receiver operator characteristic (ROC) curves drawn to generate an area under the curve (AUC) to assess criterion related validity.ResultsOf 188 children who completed cardiorespiratory sleep studies; parents completed the screening questionnaire for 186. Of this study population 15.4% had moderate to severe OSA defined by an OAHI of ≥5/h. Sixty-three (33.9%) participants were excluded due to “unsure” responses or where questions were not answered. Using the remaining 123 questionnaires a four-factor solution was found, with the 1st factor representing breathing related symptoms, explaining a high proportion of the variance. Internal consistency was acceptable with a Cronbach alpha of 0.87. ROC curves for the total score generated an AUC statistic of 0.497 and for the breathing subscale an AUC of 0.603 for moderate to severe OSA.ConclusionA well designed questionnaire with good psychometric properties had limited predictive value to screen for moderate to severe OSA in young children with DS. The use of a screening questionnaire is not recommended. Screening for OSA in this population requires objective sleep study measures.

BMI-NECK: A simple assessment of risk of obstructive sleep apnea in schizophrenia

IntroductionA high risk of obstructive sleep apnea (OSA) has been reported in patients with schizophrenia. However, existing screening questionnaires for OSA haven't been validated in this population and the impact of OSA on schizophrenia symptoms has rarely been studied. This study aimed to investigate the prevalence and impact of OSA in patients with schizophrenia and validate the existing OSA screening scales. MethodPatients with schizophrenia consecutively admitted to hospital (n = 51) and patients with schizophrenia and obesity (n = 31) were compared to healthy controls (n = 51). Apnea risk was measured with STOP-BANG, NoSAS, No-Apnea, and the Berlin Questionnaire; psychiatric symptoms were measured with the PANSS and Calgary scales and B-CATS battery. Daytime sleepiness was measured with the Epworth sleepiness scale. OSA was diagnosed using the Embletta system. ResultsOSA was found more frequently in obese schizophrenia patients than in those consecutively admitted to hospital (45% vs. 22%, p < 0.05). Significant differences between patients with and without OSA were found on the PANSS negative symptoms subscale, B-CATS digit symbol test, and in daytime sleepiness. None of the used screening scales showed satisfactory sensitivity and specificity. Obesity with coexisting neck circumference ≥41 cm in women or ≥43 cm in men (BMI-NECK model) predicted OSA in 57% of cases. ConclusionsOSA should be screened in patients with schizophrenia as it has a negative influence on psychiatric symptoms and may contribute to the higher mortality of these patients. Assessment of BMI and neck circumference proves a good screening test in ambulatory contexts.