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Risk stratification by sex and menopausal status in the multivariable apnea prediction index

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
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Abstract

Study objectives

To determine the sensitivity of the Multivariable Apnea Prediction (MAP) index for obstructive sleep apnea (OSA) in pre- and post-menopausal women with the goal of developing a tailored scoring classification approach.

Methods

Data from two studies (N = 386); the diabetes sleep treatment trial (N = 236) and EMPOWER (N = 150) were used to assess the sensitivity and specificity of the MAP index by comparing men (n = 129) to women (n = 257), and premenopausal (n = 100) to post-menopausal women (n = 136). We evaluated participants at two cut points, apnea-hypopnea index (AHI) values of ≥ 5 and ≥ 10, using 0.5 as a predicted probability cut point to establish baseline sensitivity and specificity. Contingency tables and receiver operating characteristic (ROC) analysis were conducted to evaluate the accuracy of the MAP index in predicting OSA in men versus women, and in pre-versus post-menopausal women. To select optimal predicted probabilities for classification by sex and menopausal status, Youden’s J statistic was generated from ROC coordinates.

Results

The MAP index was more sensitive to women in the AHI ≥ 5 group (76%) compared to AHI ≥ 10 group (30%). Among post-menopausal women with AHI ≥ 5, sensitivity was similar to men (98%), but less than men when AHI ≥ 10 (32%). Suggested probability cut points for women with an AHI ≥ 10 are 0.24 overall; 0.15 for premenopausal, and 0.38 for postmenopausal women.

Conclusions

Because women’s risk for OSA (AHI ≥ 10) was underestimated by the MAP index, we suggest the use of tailored cut points based on sex and menopausal status or assessing for OSA risk with an AHI of ≥ 5.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (Chasens: R01-DK096028), the National Heart Lung and Blood Institute (Burke: R01-HL107370), and through CTSI grants UL1- RR024153 and UL1-TR000005. ApneaLink Plus devices were obtained by a loan agreement from ResMed, Inc. CPAP and sham-CPAP devices obtained by a loan agreement from Philips-Respironics, Inc.

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Authors and Affiliations

  1. School of Nursing, University of Pittsburgh, 3500 Victoria St, PA, 15261, Pittsburgh, USA

    Jonna L. Morris, Staci Orbell, Paul W. Scott, Christopher C. Imes, Bomin Jeon, Lynn M. Baniak & Eileen R. Chasens

  2. VA Healthcare system, PA, Pittsburgh, USA

    Lynn M. Baniak

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  1. Jonna L. Morris
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  2. Staci Orbell
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  3. Paul W. Scott
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  4. Christopher C. Imes
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Correspondence to Jonna L. Morris.

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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 (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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The authors declare no competing interests.

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All work related to this study was completed at the University of Pittsburgh.

This study does not report on a clinical trial.

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Morris, J.L., Orbell, S., Scott, P.W. et al. Risk stratification by sex and menopausal status in the multivariable apnea prediction index. Sleep Breath 27, 1695–1702 (2023). https://doi.org/10.1007/s11325-022-02766-0

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  • DOI: https://doi.org/10.1007/s11325-022-02766-0

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