Screening for Severe Obstructive Sleep Apnea Syndrome in Hypertensive Outpatients

Abstract

We attempted to validate a two-stage strategy to screen for severe obstructive sleep apnea syndrome (s-OSAS) among hypertensive outpatients, with polysomnography (PSG) as the gold standard. Using a prospective design, we recruited outpatients with hypertension from medical outpatient clinics. Interventions included: 1) assessment of clinical data; 2) home sleep testing (HST); and 3) 12-channnel, in-laboratory PSG. We developed models using clinical or HST data alone (single-stage models) or clinical data in tandem with HST (two-stage models) to predict s-OSAS. For each model, we computed area-under-receiver-operating-characteristic curves (AUC), sensitivity, specificity, negative likelihood ratio, and negative post-test probability (NPTP). Models were then rank-ordered based upon AUC values and NPTP. HST used alone had limited accuracy (AUC=0.727, ,NPTP = 2.9%). However, models that used clinical data in tandem with HST were more accurate in identifying s-OSAS, with lower NPTP: 1) facial morphometrics (AUC=0.816, NPTP=0.6%); 2) neck circumference (AUC=0.803, NPTP=1.7%); and Multivariable Apnea Prediction Score (AUC = 0.799, NPTP =1.5%) where sensitivity, specificity and NPTP were evaluated at optimal thresholds. Therefore, HST combined with clinical data can be useful in identifying s-OSAS in hypertensive outpatients, without incurring greater cost and patient burden associated with in-laboratory PSG. These models were less useful in identifying OSAS of any severity.

Tumour necrosis factor-α/interleukin-10 ratio in patients with obstructive sleep apnoea hypopnoea syndrome

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Obstructive sleep apnea syndrome and sleep disorders in individuals with occupational injuries

“…Full-night attended PSG is an expensive diagnostic procedure and its availability is limited in many countries. However, studies have shown that portable monitors for home sleep testing in addition to clinical data (e.g., BMI) can be used to identify patients with OSAS without incurring greater costs (Gurubhagavatula et al 2013). Eijsvogel et al showed that a two-step screening with a questionnaire and a nasal flow recording was a promising way to screen for OSAS in a healthy working population (Eijsvogel et al 2016).…”

Use of Ambulatory Blood Pressure Monitoring for the Screening of Obstructive Sleep Apnea

“…To the best of our knowledge, few studies have proposed predictors or screening models that were restricted to hypertensive individuals . Only one of these studies was performed in a primary care setting .…”