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A two-tier screening model using quality-of-life measures and pulse oximetry to screen adults with sleep-disordered breathing

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Abstract

Purpose

Using quality-of-life measures and pulse oximetry, this study developed a two-tiered prediction algorithm with an aim to prioritize sleep-disordered breathing patients for polysomnography.

Methods

Data from 355 patients were evaluated to obtain their clinical information, Chinese version of Epworth sleepiness scale, and snore outcomes survey scores against respiratory disturbance index (RDI). In the first-tier screening, receiver-operating characteristics were calculated with an initial strategy of choosing optimal prediction sensitivity. The second-tier strategy investigated the association between pulse oximetry data (desaturation index of 3%) against RDI to optimize prediction specificity.

Results

The “SOS score of 55 and ESS score of 9” was the optimal combination that yielded the highest sensitivity (0.603) in the first-tier screening. The strategy can includ 94.93% possible patients (probability = 0.6) with positive predictive value of 0.997. The area under the curve (AUC) was 0.88 (p < 0.001). Desaturation index of 3% would optimized specificity (0.966, probability = 0.5) in the second-tier screening to exclude 54% of innocent patients, with negative predictive values of 0.93 and AUC of 0.951 (p < 0.001). The two-tier screening model jointly excluded 4.8% of innocent subjects and prioritized 40% of severe patients for polysomnography.

Conclusions

The prediction model is sufficiently accurate and feasible for large-scale population screening.

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Abbreviations

AUC:

area under the curve

AASM:

American Academy of Sleep Medicine

BMI:

body mass index

CESS:

Chinese version of Epworth Sleepiness Scale

CSOS:

Chinese version of Sleep Outcomes Survey

DI:

desaturation index

NPV:

negative predictive value

OSAS:

obstructive sleep apnea

PPV:

positive predictive value

PSG:

polysomnography

RDI:

respiratory disturbance index

ROC:

receiver-operating curve

SDB:

sleep-disordered breathing

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Authors and Affiliations

  1. Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, China

    Ning-Hung Chen

  2. Department of Respiratory Care, Chang Gung University, Taoyuan, Taiwan, China

    Ning-Hung Chen

  3. Department of Public Health & Biostatistics Consulting Center, School of Medicine, Chang Gung University, Taoyuan, Taiwan, China

    Min-Chi Chen

  4. Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, China

    Hsueh-Yu Li

  5. Department of Psychology, National Chengchi University, Taoyuan, Taiwan, China

    Chang-Wei Chen

  6. Department of Otolaryngology, Cathay General Hospital, 280 Sec.4 Jen-Ai Rd., Taipei, Taiwan, China

    Pa-Chun Wang

  7. Fu Jen Catholic University School of Medicine, Taipei, Taiwan, China

    Pa-Chun Wang

  8. Department of Public Health, China Medical University, Taichung, Taiwan, China

    Pa-Chun Wang

Authors
  1. Ning-Hung Chen
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  2. Min-Chi Chen
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  3. Hsueh-Yu Li
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  4. Chang-Wei Chen
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Corresponding author

Correspondence to Pa-Chun Wang.

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Chen, NH., Chen, MC., Li, HY. et al. A two-tier screening model using quality-of-life measures and pulse oximetry to screen adults with sleep-disordered breathing. Sleep Breath 15, 447–454 (2011). https://doi.org/10.1007/s11325-010-0356-1

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  • DOI: https://doi.org/10.1007/s11325-010-0356-1

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