Abstract
Purpose
The main study objective was to assess the predictive value of selected physical symptoms for screening obstructive sleep apnea and major cardiac conditions in adults with obesity, thus providing the evidence for routine symptom screening of obesity complications endorsed by obesity management clinical practice guidelines.
Methods
We performed a retrospective cohort study using patient-reported outcomes data including the physical symptoms severity component of the Memorial Symptom Assessment Scale administered through Audio Computer-Assisted Self-Interviews combined with data from the electronic medical records of an urban safety-net primary care clinic. Non-underweight ambulatory patients completing the standardized survey assessment were included. The prevalence of pre-selected symptoms and the diagnostic characteristics at various severity cut-points were determined for obstructive sleep apnea or major cardiac conditions separately for patients with and without obesity.
Results
Of the 1399 patients included in this analysis, most (77%) were non-hispanic black or hispanic. Step-wise increases in positive likelihood ratios ranging between 1.2 and 4.6 with greater severity cough, dyspnea, fatigue, bloating, dizziness, and nausea were observed for both obstructive sleep apnea and major cardiac complications. Likelihood ratio estimates for both obese and non-obese patients were statistically significant.
Conclusions
Our findings provide a basis to support current guideline recommendations for routine symptom screening to identify medical complications among patients with BMI 30 kg/m2 or greater.
Similar content being viewed by others
References
Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., et al. (2014). 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American college of cardiology/American heart association task force on practice guidelines and the obesity society. Circulation, 129(25 Suppl 2), S102–S138. doi:10.1161/01.cir.0000437739.71477.ee.
Apovian, C. M., Aronne, L. J., Bessesen, D. H., McDonnell, M. E., Murad, M. H., Pagotto, U., et al. (2015). Pharmacological management of obesity: An endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 100(2), 342–362. doi:10.1210/jc.2014-3415.
Burroughs, V. J., Nonas, C., Sweeney, C. T., Rohay, J. M., Harkins, A. M., Kyle, T. K., et al. (2008). Self-reported comorbidities among self-described overweight African-American and Hispanic adults in the United States: Results of a national survey. 16(6), 1400–1406. doi:10.1038/oby.2008.61.
Hinami, K., Smith, J., Deamant, C. D., Kee, R., Garcia, D., & Trick, W. E. (2014). Health perceptions and symptom burden in primary care: measuring health using audio computer-assisted self-interviews. Qual Life Res.
Gnambs, T., & Kaspar, K. (2015). Disclosure of sensitive behaviors across self-administered survey modes: a meta-analysis. Behavior Research Methods, 47(4), 1237–1259. doi:10.3758/s13428-014-0533-4.
Trick, W. E., Deamant, C., Smith, J., Garcia, D., & Angulo, F. (2015). Implementation of an audio computer-assisted self-interview (ACASI) system in a general medicine clinic: Patient response burden. Applied Clinical Informatics, 6(1), 148–162.
Chang, V. T., Hwang, S. S., Feuerman, M., Kasimis, B. S., & Thaler, H. T. (2000). The memorial symptom assessment scale short form (MSAS-SF). Cancer, 89(5), 1162–1171.
Portenoy, R. K., Thaler, H. T., Kornblith, A. B., Lepore, J. M., Friedlander-Klar, H., Kiyasu, E., et al. (1994). The memorial symptom assessment scale: An instrument for the evaluation of symptom prevalence, characteristics and distress. European Journal of Cancer (Oxford, England: 1990), 30A(9), 1326–1336.
Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18(7), 873–880. doi:10.1007/s11136-009-9496-9.
Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613–619.
HCUP Clinical Classifications Software (CCS) for ICD-9-CM. (2006–2009). Retrieved Nov 29, 2016 from http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp.
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults–The evidence report. National Institutes of Health (1998). Obesity Research, 6(Suppl 2), 51S–209S.
Hinami, K., Smith, J., Deamant, C. D., Kee, R., Garcia, D., & Trick, W. E. (2015). Health perceptions and symptom burden in primary care: Measuring health using audio computer-assisted self-interviews. Quality of Life Research, 24(7), 1575–1583. doi:10.1007/s11136-014-0884-4.
Mokhlesi, B., Hovda, M. D., Vekhter, B., Arora, V. M., Chung, F., & Meltzer, D. O. (2013). Sleep-disordered breathing and postoperative outcomes after bariatric surgery: Analysis of the nationwide inpatient sample. Obesity Surgery, 23(11), 1842–1851. doi:10.1007/s11695-013-0991-2.
Elixhauser, A., & Steiner, C. (2006). Obese Patients in U.S. Hospitals, 2004: Statistical brief #20. In Healthcare cost and utilization project (HCUP) statistical briefs. Rockville, MD.
Gheorghiade, M., Sopko, G., De Luca, L., Velazquez, E. J., Parker, J. D., Binkley, P. F., et al. (2006). Navigating the crossroads of coronary artery disease and heart failure. Circulation, 114(11), 1202–1213. doi:10.1161/CIRCULATIONAHA.106.623199.
Hubert, H. B., Feinleib, M., McNamara, P. M., & Castelli, W. P. (1983). Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study. Circulation, 67(5), 968–977.
Must, A., Spadano, J., Coakley, E. H., Field, A. E., Colditz, G., & Dietz, W. H. (1999). The disease burden associated with overweight and obesity. JAMA, 282(16), 1523–1529.
Grimes, D. A., & Schulz, K. F. (2005). Refining clinical diagnosis with likelihood ratios. Lancet, 365(9469), 1500–1505. doi:10.1016/S0140-6736(05)66422-7.
Ball, J. R., & Balogh, E. (2016). Improving diagnosis in health care: Highlights of a report from the national academies of sciences, engineering, and medicine. Annals of Internal Medicine, 164(1), 59–61. doi:10.7326/M15-2256.
Fass, R., Fullerton, S., Tung, S., & Mayer, E. A. (2000). Sleep disturbances in clinic patients with functional bowel disorders. The American Journal of Gastroenterology, 95(5), 1195–2000. doi:10.1111/j.1572-0241.2000.02009.x.
Jarrett, M., Heitkemper, M., Cain, K. C., Burr, R. L., & Hertig, V. (2000). Sleep disturbance influences gastrointestinal symptoms in women with irritable bowel syndrome. Digestive Diseases and Sciences, 45(5), 952–959.
Vege, S. S., Locke, G. R. 3rd, Weaver, A. L., Farmer, S. A., Melton, L. J. 3rd, & Talley, N. J. (2004). Functional gastrointestinal disorders among people with sleep disturbances: A population-based study. In Mayo Clinic proceedings, Mayo Clinic, (Vol. 79, No. 12, pp. 1501–1506). doi:10.4065/79.12.1501.
Cremonini, F., Camilleri, M., Zinsmeister, A. R., Herrick, L. M., Beebe, T., & Talley, N. J. (2009). Sleep disturbances are linked to both upper and lower gastrointestinal symptoms in the general population. Neurogastroenterology and Motility, 21(2), 128–135. doi:10.1111/j.1365-2982.2008.01181.x.
Poirier, P., Giles, T. D., Bray, G. A., Hong, Y., Stern, J. S., Pi-Sunyer, F. X., et al. (2006). Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: An update of the 1997 American heart association scientific statement on obesity and heart disease from the obesity committee of the council on nutrition, physical activity, and metabolism. Circulation, 113(6), 898–918. doi:10.1161/CIRCULATIONAHA.106.171016.
Flegal, K. M., Kruszon-Moran, D., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2016). TRends in obesity among adults in the united states, 2005 to 2014. JAMA, 315(21), 2284–2291. doi:10.1001/jama.2016.6458.
McCarthy, M. (2015). Diagnostic error remains a pervasive, underappreciated problem, US report says. BMJ, 351, h5064, doi:10.1136/bmj.h5064.
McGlynn, E. A., McDonald, K. M., & Cassel, C. K. (2015). Measurement Is essential for improving diagnosis and reducing diagnostic error: A report from the Institute of Medicine. JAMA, 314(23), 2501–2502. doi:10.1001/jama.2015.13453.
Smedley, B. D., Stith A. Y., & Nelson, A. R. (Eds.). (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington (DC).
Pope, J. H., Aufderheide, T. P., Ruthazer, R., Woolard, R. H., Feldman, J. A., Beshansky, J. R., et al. (2000). Missed diagnoses of acute cardiac ischemia in the emergency department. The New England Journal of Medicine, 342(16), 1163–1170. doi:10.1056/NEJM200004203421603.
Ogden, C. L., Lamb, M. M., Carroll, M. D., & Flegal, K. M. (2010). Obesity and socioeconomic status in adults: United States, 2005–2008. NCHS Data Brief, No, 50, pp. 1–8.
Nelson, A. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Journal of the National Medical Association, 94(8), 666–668.
Palaniappan, L., Wang, Y., & Fortmann, S. P. (2004). Coronary heart disease mortality for six ethnic groups in California, 1990–2000. Annals of Epidemiology, 14(7), 499–506. doi:10.1016/j.annepidem.2003.12.001.
Williams, D. R. (2008). The health of men: structured inequalities and opportunities. American Journal of Public Health, 98(9 Suppl), S150–S157.
Burroughs, V. J., Nonas, C., Sweeney, C. T., Rohay, J. M., Harkins, A. M., Kyle, T. K., et al. (2010). Self-reported weight loss practices among African American and Hispanic adults in the United States. Journal of the National Medical Association, 102(6), 469–475.
Acknowledgements
This study received funding from the Agency for Healthcare Research and Quality (R24 HS19481-01) to support technology implementation.
Author contributions
WT and KH contributed to study design, data collection, and data analysis. All authors contributed to data interpretation, literature search, generation of tables, drafting, and approval of the submitted manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors have no conflicts of interest to disclose.
Ethical approval
All study procedures were in accordance with the ethical standards approved by the CCHHS institutional review board.
Rights and permissions
About this article
Cite this article
Morales-Estrella, J.L., Ciftci, F.D., Trick, W.E. et al. Physical symptoms screening for cardiopulmonary complications of obesity using audio computer-assisted self-interviews. Qual Life Res 26, 2085–2092 (2017). https://doi.org/10.1007/s11136-017-1549-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-017-1549-x