Simple screening model for identifying the risk of sleep apnea in patients on opioids for chronic pain

Selvanathan, Janannii; Waseem, Rida; Peng, Philip; Wong, Jean; Ryan, Clodagh M.; Chung, Frances

doi:10.1136/rapm-2020-102388

Cited by 2 publications

(4 citation statements)

References 30 publications

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“…Seven fair-quality studies (n = 2589) assessing clinical prediction tools or screening questionnaires compared with facility-based polysomnography were included, 4 of which were new to this review (Table 1). Two evaluated the Berlin Questionnaire, 4 evaluated the STOP-BANG (snoring, tiredness, observed apnea, high blood pressure, BMI, age, neck circumference, gender) questionnaire, and 2 evaluated the Multivariable Apnea Prediction (MVAP) score—alone and when followed by an unattended home sleep test …”

Section: Resultsmentioning

confidence: 99%

“…The STOP-BANG questionnaire includes 8 dichotomous items (snoring, tiredness, observed apnea, blood pressure, BMI, age, neck circumference, and gender) . The 4 studies assessing the accuracy of the STOP-BANG questionnaire enrolled diverse populations and used different scoring criteria and additional variables to determine a positive screen result . Detailed characteristics of each study are reported in Table 1.…”

Section: Resultsmentioning

confidence: 99%

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Screening for Obstructive Sleep Apnea in Adults

Jonas¹,

Amick²,

Feltner³

et al. 2022

JAMA

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ImportanceObstructive sleep apnea (OSA) is associated with adverse health outcomes.ObjectiveTo review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force.Data SourcesPubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022.Study SelectionEnglish-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores.Data Extraction and SynthesisDual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials.Main Outcomes and MeasuresTest accuracy, excessive daytime sleepiness, sleep-related and general health–related quality of life (QOL), and harms.ResultsEighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score &gt;10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, −2.33 [95% CI, −2.75 to −1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health–related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, −1.67 [95% CI, 2.09 to −1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg).Conclusions and RelevanceThe accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health–related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Screening for Obstructive Sleep Apnea in Adults

Jonas¹,

Amick²,

Feltner³

et al. 2022

JAMA

View full text Add to dashboard Cite

show abstract

“…Simple screening model for identifying the risk of sleep apnea in patients on opioids for chronic pain: an infographic Rajnish K Gupta , 1 Eric S Schwenk 2…”

Section: Infographicmentioning

confidence: 99%

“…Selvanathan et al propose an additional step to the screening model by adding a home oxygen desaturation test. 1 With this additional tool, the authors were able to rule out OSA for nearly 38% more patients than by just doing the STOP-Bang Questionnaire or resting oxygen saturation alone. The addition of home oximetry to detect oxygen desaturation events is a simple and effective way to screen for OSA in this high-risk population while reducing the number of patients without OSA who needed to undergo a sleep study.…”

Section: Introductionmentioning

confidence: 99%