Validation of an obstructive sleep apnea symptom inventory in persons with multiple sclerosis

Abstract

Background: Improved screening for obstructive sleep apnea (OSA) could enhance multiple sclerosis (MS) clinical care; yet the utility of current screening tools for OSA have yet to be evaluated in persons with multiple sclerosis (PwMS). Objectives: The STOP-Bang Questionnnaire is an 8-item screening tool for OSA that is commonly used in non-MS samples. The aim of this study was to assess the validity of the STOP-Bang in PwMS. Methods: STOP-Bang and polysomnography data were analyzed from n = 200 PwMS. Sensitivity, specificity, positive-, and negative-predictive value (PPV and NPV) were calculated, with receiving operating characteristic (ROC) curves, for each STOP-Bang threshold score, against polysomnography-confirmed OSA diagnosis at three apnea severity thresholds (mild, moderate, and severe). Results: Nearly 70% had a STOP-Bang score of ⩾3% and 78% had OSA. The STOP-Bang at a threshold score of 3 provided sensitivities of 87% and 91% to detect moderate and severe OSA, respectively; and NPV of 84% and 95% to identify PwMS without moderate or severe OSA, respectively. Sensitivity to detect milder forms of OSA was 76%. The NPV to identify persons without milder forms of OSA was 40%. Conclusion: The STOP-Bang Questionnaire is an effective tool to screen for moderate and severe OSA in PwMS, but may be insufficient to exclude mild OSA.

Psychometric Properties of the Pittsburgh Sleep Quality Index (PSQI) in Patients with Multiple Sclerosis: Factor Structure, Reliability, Correlates, and Discrimination

“…Poor sleep quality has been shown to be an independent predictor of reduced quality of life in pwMS [ 6 ]. Additionally, a substantial proportion (37–56%) of pwMS are at elevated risk of sleep disorders such as obstructive sleep apnea [ 7 ]. The screening inventory, such as the STOP-Bang questionnaire, has been validated to assess risks for obstructive sleep apnea in pwMS [ 7 ].…”

Pathways between multiple sclerosis, sleep disorders, and cognitive function: Longitudinal findings from The Nurses’ Health Study

“…2 –4 Prior work suggests that PwMS are more likely to have an elevated risk for OSA, 5 based on a validated screening tool. 6,7 Furthermore, our research suggests a link between OSA, sleep fragmentation, and impaired objective cognitive performance in MS. 8 Yet, despite observed associations between sleep disorders and cognitive dysfunction in MS, little is known about how sleep and MS interact to impact long-term cognitive outcomes.…”

“…The utility of the STOP-Bang has been demonstrated in a variety of populations and validated in PwMS by our group. 7 We defined increased OSA risk based on adapted STOP-Bang items derived from the NHSII (see Table 1 for details and cutoffs). Generally, a STOP-Bang score of 3 or more signals elevated OSA risk.…”

Sleep-disordered breathing and neurocognitive function in multiple sclerosis: Differential associations across cognitive domains

“…They were also required to have known or suspected untreated OSA, as indicated by a pre-existing OSA diagnosis, or a score ⩾ 2 on the STOP-Bang 16 sleep apnea screening questionnaire. Although a STOP-Bang score ⩾ 3 is generally considered to optimally balance sensitivity and specificity to screen for OSA in MS, 17 a cutoff of 2 was chosen to maximize trial inclusivity in first-step screening. Exclusion criteria included: (1) physical, psychiatric, or cognitive impairment that would prevent study activity completion; (2) cardiopulmonary conditions associated with increased sleep apnea risk; (3) current treatment for sleep apnea; (4) history of surgical treatment for OSA; (5) nervous system diseases other than MS that could increase OSA risk; (6) history of concomitant central nervous system disease that could influence cognition; (7) history of concomitant systemic autoimmune disease with secondary central nervous system involvement; (8) pregnancy; (9) MS relapse within 30 days preceding enrollment; (10) systemic high-dose steroid use for an MS relapse within 30 days preceding enrollment; (11) anticipated initiation, dosage change, or discontinuation in medications that could influence cognitive test scores from baseline to follow-up; and (12) any other condition or treatment that in the opinion of the MS neurologist investigator (T.J.B.)…”

“…They were also required to have known or suspected untreated OSA, as indicated by a pre-existing OSA diagnosis, or a score ⩾ 2 on the STOP-Bang 16 sleep apnea screening questionnaire. Although a STOP-Bang score ⩾ 3 is generally considered to optimally balance sensitivity and specificity to screen for OSA in MS, 17 a cutoff of 2 was chosen to maximize trial inclusivity in first-step screening. Exclusion criteria included: (1) physical, psychiatric, or cognitive impairment that would prevent study activity completion; (2) cardiopulmonary conditions associated with increased sleep apnea risk; (3) current treatment for sleep apnea; (4) history of surgical treatment for OSA;…”