Prediction of obstructive sleep apnea: comparative performance of three screening instruments on the apnea-hypopnea inde
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE
Prediction of obstructive sleep apnea: comparative performance of three screening instruments on the apnea-hypopnea index and the oxygen desaturation index Christianne C. A. F. M. Veugen 1,2 & Emma M. Teunissen 3 & Leontine A. S. den Otter 4 & Martijn P. Kos 5 & Robert J. Stokroos 2 & Marcel P. Copper 1,5 Received: 21 May 2020 / Revised: 3 October 2020 / Accepted: 8 October 2020 # The Author(s) 2020
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 (https://doi.org/10.1007/s11325-020-02219-6) contains supplementary material, which is available to authorized users. * Christianne C. A. F. M. Veugen [email protected] 1
Department of Otorhinolaryngology Head and Neck surgery, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
2
Department of Otorhinolaryngology Head and Neck surgery, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
3
Department of Otorhinolaryngology Head and Neck surgery, Radboud Universitair Medisch Centrum, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
4
Faculty of Medicine, Universitair Medisch Centrum Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
5
Ruysdael Sleepclinic, Ruysdaelstraat 49 A1-D, 1071 XA Amsterdam, The Netherlands
Keywords Obstructive sleep apnea . Polysomnography . Scre
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