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The sawtooth sign is predictive of obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Background

The sawtooth sign in spirometry is associated with redundant upper airway tissue and snoring, but its predictive value for identifying obstructive sleep apnea (OSA) is disputed. We retrospectively assessed the predictive value of the spirometric sawtooth sign in terms of the odds ratio (OR) of association with a diagnosis of OSA compared to those without the sign.

Methods

Consecutive spirometry reports showing a sawtooth sign were identified from our laboratory. We identified 50 subjects with sawtooth sign and 100 control subjects without sawtooth sign, matched for age, BMI, and gender. The electronic medical record of each patient was queried for a diagnosis of OSA based on physician-reported diagnoses.

Results

Of the 50 subjects with sawtooth sign, 22 were found to have a current diagnosis of OSA (44%). Twenty-seven of the 100 controls (27%) also had OSA. From logistic regression analysis, sawtooth sign was associated with an increased likelihood of OSA (OR = 2.12, 95% C.I. 1.04 to 4.35). Similar results were obtained after adjustment for age, gender, pack years, and BMI (OR = 2.61, 95% C.I. 1.13 to 6.21).

Conclusions

Patients with the sawtooth sign have greater odds of having a diagnosis of OSA compared with those without the sign. If prospectively evaluated, as a result of improved identification, we hypothesize that the sawtooth sign may show an even stronger association with OSA. This relatively common finding, which adds no cost to routine spirometry, may serve as an indicator for OSA workup for some individuals not already identified as having OSA.

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Abbreviations

AHI:

Apnea hypopnea index

BMI:

Body mass index

CAD:

Coronary artery disease

OR:

Odds ratio

OSA:

Obstructive sleep apnea

PFT:

Pulmonary function test

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Acknowledgements

We are very grateful to Kenneth O. Parker and Carl D. Mottram R.R.T. for their assistance and expertise in data acquisition and analysis. We thank the laboratory staff, especially Marlene Edgar C.P.F.T., for assisting with data gathering.

Contributors

PDS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. MHB contributed to data collection and drafting of the manuscript. MHB and PDS contributed to the study design, data analysis, and revision of the manuscript. DRS contributed to data analysis. EJO contributed to final review and revision of the manuscript.

Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Michael H. Bourne Jr. & Paul D. Scanlon

  2. Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Darrell R. Schroeder

  3. Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA

    Eric J. Olson

Authors
  1. Michael H. Bourne Jr.
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  2. Paul D. Scanlon
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  3. Darrell R. Schroeder
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  4. Eric J. Olson
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Corresponding author

Correspondence to Michael H. Bourne Jr..

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Funding

No funding was received for this research.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All subjects in the study had indicated their health information could be used for research by the institution. Informed consent was not obtained from any individual participants included in the study but was not deemed necessary by the IRB given the low risk. All identifying information was excluded.

Additional information

Study performed at Mayo Clinic

Prior abstract publication/presentation: American Thoracic Society Meeting, May 2015, Denver Colorado

IRB Committee name: Mayo Foundation IRB

IRB number: 13-006217

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Bourne, M.H., Scanlon, P.D., Schroeder, D.R. et al. The sawtooth sign is predictive of obstructive sleep apnea. Sleep Breath 21, 469–474 (2017). https://doi.org/10.1007/s11325-016-1441-x

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  • DOI: https://doi.org/10.1007/s11325-016-1441-x

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