Assessing the likelihood of obstructive sleep apnea: a comparison of nine screening questionnaires
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Several questionnaires are available for the screening of obstructive sleep apnea (OSA). Herein, we compare the performance characteristics of nine available questionnaires for assessing the likelihood of OSA.
Consecutive subjects who underwent polysomnography at the sleep laboratory of the unit were included. Subjects with obstructive events and apnea hypopnea index (AHI) ≥5 were considered to have OSA. The likelihood ratios (LRs) and other performance characteristics were calculated for the following nine questionnaires: Berlin, modified Berlin, STOP, STOP-Bang and OSA50 questionnaires, sleep apnea clinical score (SACS), Epworth sleepiness scale (ESS), American Society of Anesthesiologists (ASA) checklist, and the elbow sign questionnaire.
Two-hundred and ten subjects (mean age, 46.5 years; mean body mass index [BMI], 31.9 kg/m2; 27.1% women) were included. OSA was diagnosed in 78.1% of patients; 49.5% had severe OSA (AHI ≥30). The SACS questionnaire had the highest positive LR (LR+, 5.6) and positive predictive value (95.2%). The modified Berlin questionnaire had the best negative LR (LR−, 0.2) and the highest negative predictive value (57.1%). The STOP-Bang questionnaire also had an LR− of 0.2 if BMI threshold of 25 kg/m2 (like that in the modified Berlin questionnaire) was used. Among individual items of various sleep questionnaires, the highest LR+ was obtained for neck circumference >43 cm (LR+, 4.9), while the best LR− was obtained for snoring and BMI >25 kg/m2 (LR−, 0.2).
The SACS and the STOP-Bang questionnaires (BMI threshold of 25 kg/m2) were found to provide the best positive and negative LRs, respectively, for the prediction of OSA. We believe that information from these questionnaires may help in prioritizing patients for sleep studies in high-volume centers.
KeywordsSleep disordered breathing Sleep apnea OSA Questionnaire Screening
We thank Dr. V. Nagarjuna Maturu for his inputs at the time of designing of this study.
KTP: data collection, analysis, initial drafting, and final approval of the manuscript
ISS: data collection, analysis, initial drafting, and final approval of the manuscript
RA: data collection, analysis, initial drafting, and final approval of the manuscript
ANA: data collection, analysis, initial drafting, and final approval of the manuscript
DB: data collection, analysis, initial drafting, and final approval of the manuscript
SD: involved in conception, data collection, analysis, initial drafting, and final approval of the manuscript, guarantor of the overall content
Compliance with ethical standards
No funding was received for this research.
Conflict of interest
The authors declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study for performing the procedure.
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