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Can CPAP be indicated in adult patients with suspected obstructive sleep apnea only on the basis of clinical data?

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Abstract

Background

There is scarce information about whether the diagnosis of OSA supported only by medical record data can be a useful and reliable tool to initiate a CPAP treatment.

Objectives

The aim of this study is to develop and assess the accuracy of clinical parameters for the diagnosis and prescription of CPAP in patients with suspected OSA.

Methods

Adult patients who underwent polysomnography and completed the Berlin questionnaire, a clinical record, and the Epworth sleepiness scale were included in the study. A situation was simulated in which two blinded and independent observers would be able to indicate CPAP treatment if the patients were snorers with frequent apnea reports (≥3–4 times a week) and overweight (BMI > 25 kg/m2) plus one of the following: diurnal symptoms (tiredness after sleeping or at waking time ≥3–4 times a week or Epworth sleepiness scale >11), arterial hypertension, cerebrovascular accident, coronary event, type II diabetes or cardiac arrhythmias (observer 1, clinical criteria) or on the basis of the respiratory disturbance index, significant tiredness (≥3–4 times a week) or sleepiness (Epworth >11) and associated comorbidities (observer 2, reference method). The area under the ROC curve (ABC-ROC), sensitivity, specificity, and likelihood ratios were calculated.

Results

Among 516 subjects (72 % men), the median age was 52 years, BMI 28.3 kg/m2, and RDI 19.7 events/h. The ABC-ROC, sensitivity, specificity, and positive likelihood ratio of the clinical parameters were of 0.64 to 0.65, 31 to 33 %, 97 to 98 %, and 11 to15 respectively. No differences in the diagnostic performance of the clinical criteria were observed between men and women.

Conclusions

These clinical parameters made it possible to indicate CPAP in approximately one third of the population with OSA which would have required it on the basis of their PSG and clinical history. This approach showed high specificity; hence, few patients who did not meet the criteria for CPAP use would have received this treatment.

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Acknowledgments

The authors wish to thank Ms. María Dolores Marinaro for her collaboration with the organization of the database and Ms. Jaquelina Mastantuono for the manuscript translation into English.

Conflict of interest

This study had no financial support. We declare there were no conflicts of interest related to this investigation.

Author information

Authors and Affiliations

  1. Sleep Laboratory, Pneumonology Unit, Hospital Alemán, Av. Pueyrredón 1640, CP 1418, Buenos Aires, Argentina

    Carlos Alberto Nigro & Eduardo Dibur

  2. Central Laboratory, Hospital Italiano, Potosí 4072, CP 1199, Buenos Aires, Argentina

    María Rosario Aragone

  3. Sleep Laboratory, Hospital Británico, Perdriel 74, CP 1280, Buenos Aires, Argentina

    Eduardo Borsini & Glenda Ernst

  4. Sleep Laboratory, Hospital de Clínica, Córdoba 2351, CP 1120, Buenos Aires, Argentina

    Facundo Nogueria

Authors
  1. Carlos Alberto Nigro
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  2. Eduardo Dibur
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  3. María Rosario Aragone
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  4. Eduardo Borsini
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  5. Glenda Ernst
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  6. Facundo Nogueria
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Corresponding author

Correspondence to Carlos Alberto Nigro.

Additional information

Comments:

The authors have done an excellent work in writing the manuscript entitled “Can CPAP be indicated in adult patients with suspected obstructive sleep apnea only on the basis of clinical data?”. This is a very thought provoking and meticulous work and is a good pilot data for informing larger studies. The clinical question is relevant to our field and I have always thought about it.

Harneet Walia

Cleveland, USA

Hospital Británico de Buenos Aires, Hospital de Clínica, and Hospital Alemán are part of Grupo Argentino para la Investigación de la Apnea del Sueño (GAIAS).

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Nigro, C.A., Dibur, E., Aragone, M.R. et al. Can CPAP be indicated in adult patients with suspected obstructive sleep apnea only on the basis of clinical data?. Sleep Breath 20, 175–182 (2016). https://doi.org/10.1007/s11325-015-1202-2

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  • DOI: https://doi.org/10.1007/s11325-015-1202-2

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