STOP BANG Research Articles

Spirometric abnormalities in patients with sleep-related breathing disorders.

Introduction:Patients with sleep-related breathing disorders (SRBD) have various structural and functional abnormalities of the upper airway during sleep which may get reflected on their pulmonary function tests. The aim of the study was to find the correlation between the spirometric indices and snoring, grades of apnea–hypoapnea index (AHI), and STOPBANG. There is scarcity of literature showing correlation of STOP BANG with spirometric variables.Material and Methods:Patient with SRBD fulfilling the inclusion and exclusion criteria were enrolled. The pretest probability sleep score STOPBANG and polysomnography (PSG) were calculated for all the patients. Spirometric indices like forced expiratory volume in one sec (FEV1), forced vital capacity (FVC), postbronchodilator ratio FEVI/FVC (PBDR), and peak expiratory flow rate (PEFR) were studied. Their association with snoring, different grades of obstructive sleep apnea (OSA), and STOPBANG were evaluated using statistical analysis.Results:A total of 70 patients were enrolled. Abnormalities of spirometric indices were found to be common in patients with SRBD but their association with snoring, grades of OSA, and STOPBANG were not statistically significant. There is no statistically significant correlation between body mass index (BMI) and grades of AHI.Conclusion:This study found no statistically significant correlation between spirometric parameters and STOPBANG and degree of AHI. Primary care physicians should be aware that obstructive lung disease does coexist with the sleep disordered breathing but as per this study, their statistically significant association needs further validation.

Prevalence of obstructive sleep apnea in diabetic patients.

Context:Obstructive sleep apnea (OSA)-related hypoxemia stimulates release of acute-phase proteins and reactive oxygen species that exacerbate insulin resistance and lipolysis and cause an augmented prothrombotic and proinflammatory state which can leads to premature death.Aims:This study aims to study the prevalence of OSA in diabetic patients.Setting and Design:It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital.Materials and Methods:A total of 149 type 2 diabetic patients were enrolled after taking written consent. All patients were subjected to STOP BANG questionnaire and patients falling in intermediate-high risk (score 3–8), were taken for overnight polysomnography to confirm the diagnosis of OSA (apnea hypopnea index ≥ 5).Statistical Analysis Used:Statistical Package for Social Sciences (SPSS) Version 21.0 statistical analysis software.Results:Fifty-five percent of our diabetic population were having OSA. The age of patients enrolled in the study ranged between 30 and 86 years and prevalence increases with an increase in age groups. Majority (61.7%) of our cases were males. Incremental trend in weight, body mass index (BMI), neck circumference, and waist circumference of OSA cases were found with increasing in severity of OSA. Mean levels of raised blood sugar and HbA1c were higher in severe OSA cases.Conclusions:OSA has a high prevalence in patients with type 2 diabetes mellitus. Patients with type 2 diabetes should be screened for OSA, even in the absence of symptoms, especially in individuals with higher waist circumference and BMI.

Relation between Obstructive Sleep Apnea-Hypopnea Syndrome and Glaucoma in a Sub-Saharan African Population

Introduction: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a frequent pathology worldwide whose main mechanism is a complete or partial obstruction of the upper airway. One of the pathophysiological mechanisms described in primary open-angle glaucoma is that hypoxia in the optic nerve progressively destroys the retinal cells leading to the onset and/or aggravation of glaucoma. The aim of the study was to evaluate the risk of OSA in patients with primary open-angle glaucoma. Methodology: An analytical study was conducted from January to May 2020 at the UHC. After obtaining ethical clearance, 112 patients including 50 glaucoma patients (44.64%) and 62 in the control group were enrolled. Sociodemographic and clinical data were collected from the medical records of the participants, with or without glaucoma, and a questionnaire was administered and a clinical examination performed. The STOP BANG score was used to determine the risk level of OSAHS. Statistical analyses were performed using Epi Info version 7.2. Results: A female predominance was found (60%) in the glaucoma group with a mean age of 55 ± 17 years against 49 ± 18 years in the control group. The high risk of OSAHS was more associated with glaucoma patients. In glaucoma patients, an association was found between high risk of OSAHS and snoring (OR = [1.43 - 849.53]; p = 0.029) as well as insomnia (OR = [1.36 - 482.86]; p = 0.030). Conclusion: High risk of OSAHS was found in participants with chronic open-angle glaucoma. Signs of OSAHS should be sought in chronic open-angle glaucoma as it may be a factor in its progression.

The Impact of Time-Restricted Diet on Sleep and Metabolism in Obese Volunteers.

Background and objectives: A time-restricted diet is one of the various ways to improve metabolic condition and weight control. However, until now, there have been few pieces of evidence and research to verify the methods and effectiveness of time-restricted diets on metabolic improvement and health promoting. We designed this study to make a healthy diet program and to verify the effectiveness of a time-restricted diet on general health, including sleep and metabolism, in healthy volunteers. Materials and Methods: This study was conducted in healthy adults who are obese but do not have related metabolic disease. Fifteen participants were recruited. Before and after this program, serologic tests including ketone level, questionnaires—daytime sleepiness evaluation such as the Epworth sleepiness scale and the Stanford sleepiness scale, the Korean version of the Pittsburgh sleep questionnaire index, STOP BANG to evaluate sleep apnea, the Hospital Anxiety and Depression Scale for emotion/sleep—and polysomnography (PSG) were conducted to evaluate the effects on sleep of the program. They were divided into two groups based on ketone levels that could reflect the constancy of participation in this study. We analyzed the before and after results of each group. Results: Fifteen participants (nine males and six females) completed this program without significant adverse events. Body weight after this program decreased to 78.2 ± 14.1 from 82.0 ± 15.6 kg (p = 0.539), and BMI decreased to 27.9 ± 3.8 from 29.3 ± 4.6 kg/m2 (p = 0.233). Weight loss was observed in 14 subjects except 1 participant. The results from questionnaires before and after this were not significant changes. They were classified into high/low-ketone groups according to the ketone level of the participants. In the results of the PSG, the apnea hypopnea index (25.27 ± 12.67→15.11 ± 11.50/hr, p = 0.25) and oxygen desaturation (18.43 ± 12.79→10.69 ± 10.0/hr, p = 0.004), which are indicators of sleep apnea, also improved in the high-ketone group, compared with the low-ketone group. Satisfaction interviews for this restricted diet program showed that 86% of the participants were willing to participate in the same program again. Conclusion: The time-restricted diet was successful in weight loss for a period of 4 weeks in obese participants, which did not affect the efficiency and architecture of sleep. In addition, successful weight loss and significant improvement of sleep apnea were showed in the high-ketone group. Further research is needed to demonstrate mechanisms for weight loss, sleep apnea, and time-restricted diets.

Study on assessment of Obstructive sleep apnea (OSA) risk in Obese pregnant women

Obstructive sleep apnea is a major public health concern which is associated with cardiovascular and cerebrovascular comorbidities. Eventhough association of OSA with adverse fetomaternal outcomes is documented, screening for OSA in pregnancy is a challenging task. So the purpose of our study is to assess the risk of OSA in obese pregnant ladies by using established STOP BANG Questionnare for OSA.: This cross sectional study on assessment of obstructive sleep apnea risk among the obese pregnant women was done in tertiary care centre in the rural population of Puducherry. : 21 obese pregnant women were included in our study. The mean age of our study population was 29.5 years. Most of the study subjects (85.7%) had history of snoring both reported by them and their bed partners. History of tiredness was reported by 14 patients (66.6%).Chocking or history of gasping was reported by only 4 patients (19%). Results of our study showed that 42.9% of the obese pregnant women had high risk, 42.9% had intermediate risk and 14.3% for OSA as per the STOP BANG scoring. : Thus our study subjects were having higher risk of OSA which needed further evaluation with polysomnography. Thus the STOPBANG questionnaire can be used to screen for obstructive sleep apnea (OSA) in obese women during pregnancy.

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English

A modified STOP-Bang questionnaire for OSA screening in the young, middle-age women

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.

Effects of Compression Stockings on the Risk of Obstructive Sleep Apnea (OSA) in Hemodialysis Patients

Background: Obstruction Sleep Apnea (OSA) in hemodialysis patients is a sleep disorder that involves stopping or decreasing air flow to breathe during sleep due to excess fluid in the leg. Compression Stockings (CS) with 30-40 mmHg are high pressure elastic stockings that are assumed to reduce foot fluid accumulation during the day and to prevent overnight fluid shifting to the neck.Purpose: This study aimed to determine the effects of 30-40 mmHg CS on the risk of OSA in hemodialysis patients.Method: This research used a quasi-experimental pre-posttest with control group design. A purposive sampling was applied to recruit as many as 68 hemodialysis patients. The risk score of OSA was measured using STOP Bang questionnaire. High pressure CS were given for one week to the intervention group with two OSA measurements on the 4th and 7th days. The data then were analyzed using the Post Hoc Wilcoxon test and the Mann Whitney test.Results: There was a significant difference between the risk score for OSA before and after the use of 30-40 mmHg Compression Stocking in the intervention group on day 4 (p=0.000) and day 7 (p=0.000) compared to the control group.Conclusion: High pressure CS decreased the risk of OSA in hemodialysis patients by avoiding fluid retention in the legs, thus preventing fluid shifting to the neck. CS should be recommended as an alternative to prevent the risk of OSA in hemodialysis patients.

Association between smoking and obstructive sleep apnea in adult and aged male population – A survey based study

Smoking is defined as the process where a person inhales smoke either from burnt paper or electronic cigarette with or without containing tobacco.There are various drugs and substances which can be abused in the form of smoking. In the earlier days smoking cigarettes were branded as an healthy lifestyle. One such deteriorating effect of smoking could be OSA abbreviating to obstructive sleep apnea.Obstructive sleep apnea can be defined as the obstruction of the airway either completely or partially during the sleep. India being a country with a huge population of smokers has inadequate public health awareness. The aim of the study is to analyse if there is any association between smoking and obstructive sleep apnea. Our study is a survey based study among the Indian population.No ethical approval was required from the study due to the self volunteering of the participants.Sample size of this study was n=100. Pre tested questionnaire containing questions based on smoking,sleep patterns derived from Berlin’s &amp; STOP BANG questionnaire. Questionnaire was circulated online among 100 participants above the age of 18 using Google Forms. The results were first imported to Excel then to SPSS software for further analysis. The present study population had male participation of 57%, and female participation of 43%, 59% of the study population were not aware of obstructive sleep apnea,75% of the participants declared that they are not addicted to smoking yet 25% are addicted,96% of the participants population found the study to be useful. The present survey study concluded that there may be an association between smoking and obstructive sleep apnea in the adult and aged population.

Prevalence of obstructive sleep apnea risk and associated factors among patients with type 2 diabetes mellitus on follow up at Jimma Medical Center, Southwest Ethiopia

BackgroundObstructive sleep apnea (OSA) is a periodic, partial or complete obstruction in the upper airway during sleep that disrupts normal sleep pattern. Despite its significant morbidities and mortality, the majority of patients with OSA remain undiagnosed. The purpose of this study was to assess the prevalence and associated factors of OSA risk among type 2 diabetes patients on follow up at Jimma Medical Center from January 13 to March 2, 2020. MethodA hospital based cross-sectional study was conducted and consecutive sampling technique was employed. The stop bang questionnaire was used to assess OSA risk. Data were collected using structured questionnaire and entered into EPI data 3.1 and exported to SPSS version 20 for analysis. Logistic regression was employed to identify factors associated with high risk OSA. A variable having a p-value of <0.2 in the bivariate model was subjected to multivariate analysis. Adjusted odds ratios were calculated at 95% confidence interval and considered significant with a p-value of ≤0.05. Result253 patients seen in the outpatient clinic were involved with mean age and mean duration of diabetes was 50.27 ± 14.08 and 6.48 ± 5.20 years respectively. The study finding showed that the prevalence of high risk OSA was 45.5%. According to multivariate analysis comorbid hypertension (AOR = 2; 95% CI: 1.04, 3.89), physical inactivity (AOR = 2.11; 95% CI: 1.11,4), BMI ≥ 30 kg/m2: (AOR = 5.41; 95% CI: 1.68,17.3 and neck circumference > 40 cm: (AOR = 6.3; 95% CI: 2.8,14.2 were independently associated with an increased risk of OSA. ConclusionThere is high number of participants with high risk of OSA. BMI of ≥ 30 kg/m2, physical inactivity, neck circumference of > 40 cm and comorbid hypertension were associated with high risk OSA among participants. Early detection and appropriate interventions are important among high risk groups.

An assessment of risks associated with obstructive sleep apnea and its relationship with adverse health outcomes among pregnant women. A multi-hospital based study.

Physiological changes in pregnancy increase the vulnerability of antenatal women to develop obstructive sleep apnoea (OSA). It is a known cause of several adverse health outcomes in pregnancy. To assess the risk status of OSA in pregnant women and to study its association with adverse maternal outcomes, fatigability, and daytime sleepiness. Pregnant women were interviewed to assess for the risk of OSA, fatigability, and daytime sleepiness. STOP BANG, the fatigue severity scale, and the Epworth sleepiness scale were used to assess these parameters. The mean age of the 214 participants was 27.2 ± 4.7 years. 7 (3.3%) participants had a history of snoring louder than the volume of normal talking, or of being loud enough to be heard past closed doors. A moderate risk status of OSA was present among 3 (1.4%) participants. 45 (21.0%) pregnancies were high risk in nature. The risk status of OSA was associated with a high risk status of pregnancies among the participants (p = 0.0088). 41 (19.2%) participants had a history of significant fatigue over the previous week of the study. 7 (3.3%) participants reported mild to severe excessive daytime sleepiness. A history of snoring loudly (p = 0.0179) and a OSA risk status (p = 0.0027) was associated with excessive daytime sleepiness. A risk status for OSA was associated with a high risk pregnancy status and excessive daytime sleepiness among pregnant women in the current setting. Therefore, pregnant women with these conditions need to be evaluated for OSA. They also need to be suitably managed to ensure the healthy well-being of the mother and the baby.

Managing obstructive sleep apnea patients with CPAP failure with a novel Lateral Pharyngoplasty as a stand-alone procedure.

Obstructive sleep apnea syndrome (OSAS) is caused by a complete or partial obstruction of the upper airway. A new Cahali lateral pharyngoplasty as a stand-alone procedure for the treatment of OSA patients, whatever the level and pattern of airway obstruction in patients with CPAP failure or non-compliant patients, is it? 40 patients with known OSAS non-compliant with CPAP or CPAP failures included. BMI, Stop-Bang score, and sleep study parameters were reported before and after the new Cahali pharyngoplasty operation. Preoperative DISE was done for all cases. There were 28 (70%) cases with successful operation outcomes, and 12 (30%) failed cases. Postoperative Stop Bang score, AHI, snoring index were significantly reduced in comparison to preoperative data (p-value <0.001); however, minimal SpO2 and baseline SpO2 were significantly increased in comparison to preoperative data. There was a significant improvement in AHI postoperative. Patients collapse at the level of lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, all significantly predict failure outcome of the operation (p-value=0.022). However, the absence of laryngeal collapse (L0) had a successful prediction outcome. The high snoring index significantly predicts operation failure. However, preoperative high baseline SpO2 predicts operation success significantly. The new Cahali lateral pharyngoplasty can be used as a stand-alone procedure in the absence of lateral wall collapse at the level of the hypopharynx (LH), high tongue base collapse (TH), laryngeal collapse (L1) or tongue palate interaction.

Improving the identification and triage of patients with Obstructive Sleep Apnea who require treatment: The Merlin tool for high risk populations

Aims and objectives: A number of validated questionnaires are routinely used to screen specific populations for obstructive sleep apnea (OSA) including the STOP, STOP-Bang, Berlin and Epworth sleepiness scales. These questionnaires depend on subjective questions which cannot be independently confirmed. The subjective questions also result in high sensitivity and low specificity as they are generally resulting from OSA. The aim of the study was to identify verifiable and independently measurable risk factors and increase specificity to limit the number of polysomnography evaluations (PE) and lower healthcare cost. Methods: A retrospective data collection of patients (N=164) enrolled for PE was performed which included the results of STOP, STOP Bang, Berlin and Epworth questionnaires as well as demographic and health related variables. OSA was defined as an AHI>=15 obtained from an overnight PE. Sensitivity and specificity of each questionnaire as well as for combinations of other, independently verifiable factors (IVF) was calculated. A new questionnaire was devised including the IVFs and data was prospectively collected from patients undergoing PE (N=209). Results: The retrospective analysis identified age>50, male, BMI>30, alcohol consumption >21 per week, collar circumference>16 inches (40 cm), diabetes, use of antidepressants and high blood pressure as the most influential factors. Prospective data collection was performed and analysis resulted in a new scale with a cut off of 3 based on the following equation: OSA=(2*BMI>30)+(Age>50)+(Male)+(neck>16)+(diabetes)+(alcohol>21unit/week). For every 100 patients with OSA, the total number enrolled for PE based on each screening tool were respectively for STOP 92 enrolled of whom 41 were diagnosed and 1 patient missed, for STOP-Bang 94 enrolled, 42 identified and 1 missed, Berlin 83 enrolled, 36 identified and 7 missed, Epworth 46 enrolled, 22 identified and 20 missed and our new screening tool 65 enrolled, 35 identified and 8 missed. Conclusion: In a high risk population of patients referred for PE we identified independently verifiable factors associated with OSA and with only 2/3 of patients enrolled for PE, we identified most OSA cases while keeping the number of missed cases down.

Gender Differences in Obstructive Sleep Apnea: The Value of Sleep Questionnaires with a Separate Analysis of Cardiovascular Patients.

Background: Gender affects the clinical presentation of obstructive sleep apnea (OSA). The classic OSA symptoms, such as sleepiness, snoring, and apnea, are not so frequent in women. Objectives: To evaluate possible gender differences in questionnaires used for OSA prediction, such as the Epworth Sleepiness Scale (ESS), STOP, STOP Bang (SB), Berlin Questionnaire (BQ), Athens Insomnia Scale (AIS), and Fatigue Scale (FS). Methods: 350 males were matched with 350 women referred to a sleep clinic, according to OSA severity. All responded to the questionnaires and underwent a sleep study. Cardiovascular disease (CVD) patients were separately analyzed. Results: ESS did not differ between genders. SB was higher in males, whereas STOP, BQ, AIS, and FS were higher in females. BQ presented the highest sensitivity in both genders, whereas STOP exhibited the highest specificity in males and ESS in females. AIS and FS were more sensitive and SB more specific in females, whereas BQ was more specific in males. For severe OSA, the predictive values of SB and BQ were almost similar for both genders; however AIS and FS were higher in women. CVD patients presented higher scores, independent of gender, except for AIS, which was higher in females. Conclusion: Gender-specific evaluation of questionnaires is necessary to prevent OSA under-diagnosis.

The Brazilian-Portuguese version of the Sleep Hygiene Index (SHI): validity, reliability and association with depressive symptoms and sleep-related outcomes.

ObjectiveTo translate the Sleep Hygiene Index (SHI) to Brazilian Portuguese, to describe its psychometric properties and to show its association with sleep quality, daytime sleepiness, risk for sleep apnea and depressive symptoms.MethodsThirty subjects participated in the cultural adaptation and the item clarity evaluation. Twenty subjects answered the instrument in three different time-points for test-retest reliability. Eighty adult workers completed the SHI, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Beck Depression Inventory (BDI) and the STOP-BANG (S-B).ResultsSHI shows an acceptable internal consistency (Cronbach’s α=0.75), as well as a high reproducibility (intraclass correlation=0.972, p<0.01). The three final factors of confirmatory factor analysis extract an average of 48.22% of the total sample variance. Worse sleep hygiene (higher SHI score) correlated with poor sleep quality (r=0.398, p<0.001), excessive daytime sleepiness (r=0.406, p<0.001) and depressive symptoms (r=0.324, p=0.003). No correlations with S-B were found.ConclusionsSHI presents satisfactory-to-optimal psychometric properties. This instrument is useful for treatment planning and management of sleep hygiene practices. Thus, it represents a reliable way of assessing sleep hygiene quantitatively in both research and clinical settings.

Prevalence of Obstructive Sleep Apnea in Type 2 Diabetes

Introduction: Diabetes are common disorder that often coexist as they have similar risk factors including obesity. As 10% increase in weight accelerates the risk of OSA by 10%it is not surprising to see both disorder in the patient.&#x0D; Methods: All the patients who attended to our sleep clinic in OM Hospital and Research Centre were asked about diabeteic history. Those who are already diagnosed as diabetics and on medications or diet control were enrolled into the study. STOP BANG questionnaire was used to categorize the patients for probable obstructive sleep apnea.&#x0D; Results: Among 67 patients who underwent diagnostic polysomnography 22 patients had normal AHI, 19 had intermittent snoring and rest had normal diagnostic polysomnography. Among 45 patients 5 had predominantly central sleep apnea and 40 had obstructive sleep apnea.&#x0D; Conclusion: In our study that OSA is very common in patients with Type 2 diabetes and worse glycaemic control is a high index of suspicion and sleep history especially for OSA should be included in all the patients of type 2 diabetes. Any patients with uncontrolled diabetes despite medications independent of obesity should be screened for OSA.

COMPARING THE BERLIN QUESTIONNAIRE, STOP, STOP-BANG, ASA CHECKLIST, AND EPWORTH SLEEPINESS SCALE TO IDENTIFY PATIENTS WITH OSA HYPOPNEA SYNDROME

SESSION TITLE: Clinical Prediction and Diagnosis of OSA SESSION TYPE: Original Investigations PRESENTED ON: 10/23/2019 10:45 AM - 11:45 AM PURPOSE: Background: Obstructive sleep apnea syndrome is a common disorder with significant morbidity and mortality. Different questionnaires have been used to evaluate patients with Obstructive sleep apnea/hypopnea syndrome. Standard polysomnography (PSG) is diagnostic gold standard for OSA. PSG is expensive, time consuming and not available everywhere. OBJECTIVE: The aim of the study was to evaluate the clinical utility of different questionnaires: Stop, Stop Bang, Berlin questionnaire, ASA checklist, Epworth Sleepiness Scale to identify patients at high risk for OSAHS compared with in-laboratory PSG and to identify the best OSA questionnaire for screening. METHODS: This prospective cross-sectional study was conducted on 170 patients, suspected to have OSAHS recruited from sleep clinic, (66% were females, with mean age 46±13 years, & BMI 39±8.3kg/m2) and divided into group of non OSA (n=70) and group of OSA (n=100).. All patients completed five questionnaires ( STOP, STOP-Bang, Berlin questionnaire, ASA chicketlist and ESS score), For each questionnaire, patients were divided into high risk and low risk. Then, PSG was performed for all patients. Apnea-Hypopnea Index was calculated to assess the diagnosis and severity of OSA. Severity of OSA was categorized as none (AHI < 5/h), mild (AHI ≥ 5 to < 15/h), moderate-to-severe (≥ 15 to < 30/h), and severe (AHI ≥ 30/h). Estimated OSA risk was compared to a diagnosis of OSA. The sensitivity, specificity,PPV, and NPV were calculated for each questionnaire. RESULTS: The prevalence of OSA was 12.5% using an AHI ≥5/h, 6.5% for an AHI ≥15/h and 40% for an AHI≥30/h. The STOP-Bang, Berlin questionnaires & ESS had a high sensitivity (90%,85% & 91% for AHI ≥15/h, and 91.2%,87% & 84% for AHI ≥30/h respectively), but the specificity was low (57%, 48% & 38% and 44%, 41% & 41%, respectively). In contrast, the sensitivity of the ASA checklist was not high enough (61% for AHI ≥15/h, 65% for AHI ≥30/h) to be useful in a clinical setting, whereas the specificity was relatively good (80% and 41%, respectively). The sensitivity and specificity values of the STOP questionnaire (for AHI ≥15/h, for AHI ≥30/h) fell between those of the STOP-Bang and the Berlin questionnaire.PPV (92%,86%, 85%, 92.5% & 89% for AHI ≥15/h and (83%, 76%, 75%, 85% & 77.5% AHI≥30/h,NPV 60%,46%,53%, 34% & 43% ≥15/h and 70%,59%,54%,49%,& 57%,AHI ≥30/h and area under the ROC curve at AHI≥ 15 was and 0.81,0.67,0.68,0.73, &0.78 and 0.77,0.64,0.66,0.71, &0.70 AHI ≥ 30. CONCLUSIONS: This study suggested that Berlin and STOP-BANG are more sensitive and accurate than ESS, ASA checklist & STOP questionnaire for OSA screening & severity prediction of OSA. CLINICAL IMPLICATIONS: : STOP-BANG and Berlin questionnaires are considered valid tools for the diagnosis and severity prediction of OSA with high sensitivity and specificity in comparison with PSG, and hence the number of patients referred for PSG could be decreased. DISCLOSURES: no disclosure on file for Hend Abd-rlrahiem; no disclosure on file for Azza Ahmad; no disclosure on file for Fatma Mohamed; No relevant relationships by Hamdy Mohammadien, source=Web Response no disclosure on file for Abd-elbast Saleh

The Association of Obstructive Sleep Apnea Syndrome and Accident Risk in Heavy Equipment Operators.

Background and Objectives: Obstructive sleep apnea syndrome (OSAS) is the most frequent sleep disorder, characterized by the repeated collapse of the upper respiratory tract during sleep. In this study, we aimed to determine the prevalence of OSAS in heavy equipment operators and to determine the relationship between the work accidents that these operators were involved in and the OSAS symptoms and severity. In doing this, we aimed to emphasize the association of OSAS, which is a treatable disease, and these accidents, which cause loss of manpower, financial hampering, and even death. Materials and Methods: STOP BANG questionnaire was provided to 965 heavy equipment operators and polysomnography (PSG) was performed, in Izmir Esrefpasa Municipality Hospital, to the operators at high risk for OSAS. Demographic data, health status, and accidents of these operators were recorded. Results: All operators who participated in the study were male. The ages of the cases ranged from 35 to 58 and the mean age was 45.07 ± 5.54 years. The mean STOP BANG questionnaire results were 4.36 ± 3.82. In total, 142 operators were identified with high risk for OSAS and PSG could be performed on 110 of these 142 operators. According to the PSG results of the operators, 41 (37.3%) patients had normal findings, while 35 (31.8%) had mild, 20 (18.2%) had moderate, and 14 (12.7%) had severe OSAS. Among those 110 patients, 71 (64.5%) of the cases had no history of any accidents, 25 (22.8%) were almost involved in an accident due to sleepiness, and 14 (12.7%) were actually involved in an accident. There was a statistically significant relationship between the accident rate and OSAS severity (p: 0.009). Conclusion: Based on the data acquired in the present study, a positive correlation was determined between the accident statuses of drivers with OSAS severity. We want to attract attention to the necessity of evaluating the OSAS symptoms in professional heavy equipment operators during the certification period and at various intervals afterwards, and to carry out OSAS evaluations by PSG for those having a certain risk.

Abstract P2061: Cardiovascular Risk Profile of a Young Adult Population Assisted by a Family Healthcare Unit in Rio De Janeiro With High Risk for Obstructive Sleep Apnea Screened By Stop-Bang Questionnaire and Epworth Sleepiness Scale

Objective: To establish the relationship between cardiovascular (CV) risk profile and detected risk of Obstructive Sleep Apnea (OSA) in two questionnaires - STOP-BANG (SB) and Epworth Sleepiness Scale (ESS), in a young population of adults registered in a Family Health Unit (USF) located in Rio de Janeiro, Brazil - LapARC cohort study. Methods: This cross-sectional population study enrolled adults between 20-50 years old, registered in a primary healthcare unit in Rio de Janeiro. A database is being developed including sociodemographic and anthropometric data, and CV risk factors. Office blood pressure (OBP) and Home Blood Pressure Monitoring (HBPM) (7-day protocol) were obtained with Omron-705CP. Furthermore, OSA was investigated by SB and ESS. Patients with a high risk for OSA in either of these two questionnaires were subsequently assigned for polysomnography (PSG). Results: A total of 391 subjects were evaluated [40% males, 38 ± 8 years], where 96 (25%) were identified as high risk for OSA by the SB questionnaire and 143 (37%) by ESS. The most common CV risk factor was physical inactivity (45%), followed by dyslipidemia (34%) and obesity (24%). By OBP, the prevalence of hypertension was 24% while by HBPM was 18%, with a low concordance between them (kappa=0.385). Subjects with a high risk by SB are older, with a higher prevalence of obesity (50% vs 16%), hypertension (29% vs 9%), and higher office BP and HBPM. On the other hand, individuals with high-risk by ESS were more obese (34% vs 19%), with increased waist circumference (48% vs 32%), higher prevalence of dyslipidemia (43% vs 41%) and metabolic syndrome (13% vs 7%). However, there was no difference in BP levels. Among the subjects assigned to PSG, 46% had a diagnosis of OSA (AHI ≥ 5/hour) and 23% of moderate/severe OSA (AHI&gt;15/hour). The best predictor of OSA was SB, positive in 100% of subjects with moderate/severe OSA, while ESS was positive in only 20% of them. Conclusion: This young and apparently healthy population presented a high prevalence and risk for OSA. The SB had a higher association with higher BP levels, while ESS was associated with a worse metabolic profile. Therefore, SB questionnaire seems to be the best predictor for moderate/severe OSA in this population.

Assessing quality of sleep, its functional outcome and excessive day time sleepiness in shift workers and non-shift workers

Background and Aims: Shift work has been growing more prevalence and involves irregular working hours when compared to daytime work schedule. This study aims to assess sleep quality, its functional outcome, excessive daytime sleepiness and incidence of obstructive sleep apnea between shift and non-shift workers.&#x0D; Methods: The study candidates were randomly drawn Nepalese, from age 18 years and older, and were enrolled between January 2018 to January 2019. The subjects were divided into either: Shift work or Non-Shift work. The assessment measures were done with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), STOP-BANG and FOSQ-10 (Functional Outcome of Sleep Quality – 10), using a standard form.&#x0D; Results: A total of 358 participants were included in the main study (176 Non-shift workers, and 182 Shift-workers). The mean BMI among the two group were not significantly different (p =0.43). There was significant difference with 25% Non-Shift workers and 41.21% of Shift workers were found to have Abnormal Sleepiness in the Epworth Sleepiness Scale score (p=0.004). Shift workers showed comparatively higher values for Epworth Sleepiness scale compared to Non-Shift workers in Mann-Whitney analysis, with mean rank 194.11 versus 164.39, respectively, p=0.006. Similarly, 26.29% Non-Shift workers and 36.72% Shift workers were found to have abnormal FOSQ-10 scores, χ2 (1) =4.44, p=0.035. 7.95% of Non-Shift workers and 6.59% of Shift-workers were found to have high risk of OSA in STOP BANG questionnaire, with no significant association, p=0.725.&#x0D; Conclusions: Shift work caused excessive daytime sleepiness and had worse functional outcome but did not increase probability of obstructive sleep apnea.