Comparison of commonly used questionnaires to identify obstructive sleep apnea in a high-risk population

Kirk Kee, John Dixon, Jonathan Shaw, Elena Vulikh, Markus Schlaich, David M. Kaye, Paul Zimmet, Matthew T. Naughton

Research output: Contribution to journalArticle

Abstract

Study Objectives: Sleep apnea is associated with adverse health outcomes. Despite being an important comorbidity in obesity, type 2 diabetes, heart failure, and resistant hypertension, it is underdiagnosed in these patient groups. An inexpensive and readily accessible sleep apnea screening tool would help address this problem. We sought to compare three commonly used screening tools. Methods: We recruited 812 patients who had not previously been investigated for sleep apnea from our institution's diabetes (n = 512), obesity (n = 129), resistant hypertension (n = 74) and heart failure (n = 43) clinics. Patients completed three frequently used sleep apnea screening questionnaires (STOP-BANG, Berlin, and OSA50). A total of 758 patients had a valid (> 4 hours' duration) level 3 home sleep study. Studies were reported by a sleep physician and were deemed positive if they recorded a respiratory event index (REI) ≥ 15 events/h. Results: The 758 patients with valid sleep studies were age 59 ± 11 years and 63% were male. A total of 38% of patients had a positive test. The respective sensitivities and specificities of the screening questionnaires at the recommended screening thresholds (REI ≥ 15 events/h) were STOP-BANG ≥ 3 (95% and 19%), STOP-BANG ≥ 5 (60% and 69%), Berlin (75% and 38%), and OSA50 (88% and 21%). We identified six independent predictors (age, sex, body mass index, neck circumference, snoring ≥ 3 days per week, observed apnea ≥ 3 days per week). However, combining these factors was no better than the STOP-BANG in predicting sleep apnea. All patients with a STOP-BANG < 3 had an REI < 30 events/h. Conclusions: There is a high prevalence of undiagnosed symptomatic sleep apnea in high-risk patient groups. The STOP-BANG questionnaire appeared superior, though all questionnaires had significant limitations. Incorporation of STOP-BANG ≥ 3 in this high-risk population might reduce the need for sleep testing in a resource-constrained setting.

Original languageEnglish
Pages (from-to)2057-2064
Number of pages8
JournalJournal of clinical sleep medicine
Volume14
Issue number12
DOIs
Publication statusPublished - 15 Dec 2018

Fingerprint

Obstructive Sleep Apnea
Sleep Apnea Syndromes
Population
Sleep
Berlin
Heart Failure
Obesity
Hypertension
Snoring
Surveys and Questionnaires
Apnea
Type 2 Diabetes Mellitus
Comorbidity
Body Mass Index
Neck
Physicians
Sensitivity and Specificity
Health

Cite this

Kee, Kirk ; Dixon, John ; Shaw, Jonathan ; Vulikh, Elena ; Schlaich, Markus ; Kaye, David M. ; Zimmet, Paul ; Naughton, Matthew T. / Comparison of commonly used questionnaires to identify obstructive sleep apnea in a high-risk population. In: Journal of clinical sleep medicine. 2018 ; Vol. 14, No. 12. pp. 2057-2064.
@article{b3114dd97fce439e9c81b1d88884b675,
title = "Comparison of commonly used questionnaires to identify obstructive sleep apnea in a high-risk population",
abstract = "Study Objectives: Sleep apnea is associated with adverse health outcomes. Despite being an important comorbidity in obesity, type 2 diabetes, heart failure, and resistant hypertension, it is underdiagnosed in these patient groups. An inexpensive and readily accessible sleep apnea screening tool would help address this problem. We sought to compare three commonly used screening tools. Methods: We recruited 812 patients who had not previously been investigated for sleep apnea from our institution's diabetes (n = 512), obesity (n = 129), resistant hypertension (n = 74) and heart failure (n = 43) clinics. Patients completed three frequently used sleep apnea screening questionnaires (STOP-BANG, Berlin, and OSA50). A total of 758 patients had a valid (> 4 hours' duration) level 3 home sleep study. Studies were reported by a sleep physician and were deemed positive if they recorded a respiratory event index (REI) ≥ 15 events/h. Results: The 758 patients with valid sleep studies were age 59 ± 11 years and 63{\%} were male. A total of 38{\%} of patients had a positive test. The respective sensitivities and specificities of the screening questionnaires at the recommended screening thresholds (REI ≥ 15 events/h) were STOP-BANG ≥ 3 (95{\%} and 19{\%}), STOP-BANG ≥ 5 (60{\%} and 69{\%}), Berlin (75{\%} and 38{\%}), and OSA50 (88{\%} and 21{\%}). We identified six independent predictors (age, sex, body mass index, neck circumference, snoring ≥ 3 days per week, observed apnea ≥ 3 days per week). However, combining these factors was no better than the STOP-BANG in predicting sleep apnea. All patients with a STOP-BANG < 3 had an REI < 30 events/h. Conclusions: There is a high prevalence of undiagnosed symptomatic sleep apnea in high-risk patient groups. The STOP-BANG questionnaire appeared superior, though all questionnaires had significant limitations. Incorporation of STOP-BANG ≥ 3 in this high-risk population might reduce the need for sleep testing in a resource-constrained setting.",
keywords = "Diabetes, Heart failure, Hypertension, Obesity, Sleep apnea questionnaires",
author = "Kirk Kee and John Dixon and Jonathan Shaw and Elena Vulikh and Markus Schlaich and Kaye, {David M.} and Paul Zimmet and Naughton, {Matthew T.}",
year = "2018",
month = "12",
day = "15",
doi = "10.5664/jcsm.7536",
language = "English",
volume = "14",
pages = "2057--2064",
journal = "Journal of Clincal Sleep Medicine",
issn = "1550-9389",
publisher = "AMER ACAD SLEEP MEDICINE",
number = "12",

}

Comparison of commonly used questionnaires to identify obstructive sleep apnea in a high-risk population. / Kee, Kirk; Dixon, John; Shaw, Jonathan; Vulikh, Elena; Schlaich, Markus; Kaye, David M.; Zimmet, Paul; Naughton, Matthew T.

In: Journal of clinical sleep medicine, Vol. 14, No. 12, 15.12.2018, p. 2057-2064.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of commonly used questionnaires to identify obstructive sleep apnea in a high-risk population

AU - Kee, Kirk

AU - Dixon, John

AU - Shaw, Jonathan

AU - Vulikh, Elena

AU - Schlaich, Markus

AU - Kaye, David M.

AU - Zimmet, Paul

AU - Naughton, Matthew T.

PY - 2018/12/15

Y1 - 2018/12/15

N2 - Study Objectives: Sleep apnea is associated with adverse health outcomes. Despite being an important comorbidity in obesity, type 2 diabetes, heart failure, and resistant hypertension, it is underdiagnosed in these patient groups. An inexpensive and readily accessible sleep apnea screening tool would help address this problem. We sought to compare three commonly used screening tools. Methods: We recruited 812 patients who had not previously been investigated for sleep apnea from our institution's diabetes (n = 512), obesity (n = 129), resistant hypertension (n = 74) and heart failure (n = 43) clinics. Patients completed three frequently used sleep apnea screening questionnaires (STOP-BANG, Berlin, and OSA50). A total of 758 patients had a valid (> 4 hours' duration) level 3 home sleep study. Studies were reported by a sleep physician and were deemed positive if they recorded a respiratory event index (REI) ≥ 15 events/h. Results: The 758 patients with valid sleep studies were age 59 ± 11 years and 63% were male. A total of 38% of patients had a positive test. The respective sensitivities and specificities of the screening questionnaires at the recommended screening thresholds (REI ≥ 15 events/h) were STOP-BANG ≥ 3 (95% and 19%), STOP-BANG ≥ 5 (60% and 69%), Berlin (75% and 38%), and OSA50 (88% and 21%). We identified six independent predictors (age, sex, body mass index, neck circumference, snoring ≥ 3 days per week, observed apnea ≥ 3 days per week). However, combining these factors was no better than the STOP-BANG in predicting sleep apnea. All patients with a STOP-BANG < 3 had an REI < 30 events/h. Conclusions: There is a high prevalence of undiagnosed symptomatic sleep apnea in high-risk patient groups. The STOP-BANG questionnaire appeared superior, though all questionnaires had significant limitations. Incorporation of STOP-BANG ≥ 3 in this high-risk population might reduce the need for sleep testing in a resource-constrained setting.

AB - Study Objectives: Sleep apnea is associated with adverse health outcomes. Despite being an important comorbidity in obesity, type 2 diabetes, heart failure, and resistant hypertension, it is underdiagnosed in these patient groups. An inexpensive and readily accessible sleep apnea screening tool would help address this problem. We sought to compare three commonly used screening tools. Methods: We recruited 812 patients who had not previously been investigated for sleep apnea from our institution's diabetes (n = 512), obesity (n = 129), resistant hypertension (n = 74) and heart failure (n = 43) clinics. Patients completed three frequently used sleep apnea screening questionnaires (STOP-BANG, Berlin, and OSA50). A total of 758 patients had a valid (> 4 hours' duration) level 3 home sleep study. Studies were reported by a sleep physician and were deemed positive if they recorded a respiratory event index (REI) ≥ 15 events/h. Results: The 758 patients with valid sleep studies were age 59 ± 11 years and 63% were male. A total of 38% of patients had a positive test. The respective sensitivities and specificities of the screening questionnaires at the recommended screening thresholds (REI ≥ 15 events/h) were STOP-BANG ≥ 3 (95% and 19%), STOP-BANG ≥ 5 (60% and 69%), Berlin (75% and 38%), and OSA50 (88% and 21%). We identified six independent predictors (age, sex, body mass index, neck circumference, snoring ≥ 3 days per week, observed apnea ≥ 3 days per week). However, combining these factors was no better than the STOP-BANG in predicting sleep apnea. All patients with a STOP-BANG < 3 had an REI < 30 events/h. Conclusions: There is a high prevalence of undiagnosed symptomatic sleep apnea in high-risk patient groups. The STOP-BANG questionnaire appeared superior, though all questionnaires had significant limitations. Incorporation of STOP-BANG ≥ 3 in this high-risk population might reduce the need for sleep testing in a resource-constrained setting.

KW - Diabetes

KW - Heart failure

KW - Hypertension

KW - Obesity

KW - Sleep apnea questionnaires

UR - http://www.scopus.com/inward/record.url?scp=85058813179&partnerID=8YFLogxK

U2 - 10.5664/jcsm.7536

DO - 10.5664/jcsm.7536

M3 - Article

VL - 14

SP - 2057

EP - 2064

JO - Journal of Clincal Sleep Medicine

JF - Journal of Clincal Sleep Medicine

SN - 1550-9389

IS - 12

ER -