Use of a screening tool for detection of sleep-disordered breathing

AbstractBackground:Sleep apnoea, whether obstructive or central, is usually diagnosed by polysomnography. A simpler tool for screening high risk populations may be of value.Methods:We compared a portable device using nasal pressure cannulae and a high-sensitivity pressure sensor (the ApneaLink®) with our standard polysomnography technique for diagnosing sleep apnoea (using the Embletta® device), in 67 patients being investigated for possible sleep apnoea. The patients' average age was 52.6, 79 per cent were male, the mean body mass index was 32.3, and the mean Epworth sleepiness score was 13.0.Results:Twenty-five patients (45 per cent) were identified as having an apnoea–hypopnoea index of >15, as measured by the Embletta. The mean (standard deviation) apnoea–hypopnoea index was 21.5 ± 23.0 as measured by the Embletta and 24.3 ± 26.2 as measured by the ApneaLink. The sensitivity of the ApneaLink for an apnoea–hypopnoea index cut-off point of 15 was 92 per cent and the specificity was 96.7 per cent. The negative predictive value of the ApneaLink for an apnoea–hypopnoea index of ≤15 was 94 per cent.Conclusions:The ApneaLink is a useful tool for screening patients thought to have possible sleep apnoea, and for selecting patients for definitive diagnostic testing.

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Validity of self-reported weight: a study of urban brazilian adults

Revista de Saúde Pública ◽

10.1590/s0034-89101993000400007 ◽

1993 ◽

Vol 27 (4) ◽

pp. 271-276 ◽

Cited By ~ 61

Author(s):

Maria I. Schmidt ◽

Bruce B. Duncan ◽

Mário Tavares ◽

Carísi A. Polanczyk ◽

Lúcia Pellanda ◽

...

Keyword(s):

Body Mass Index ◽

Standard Deviation ◽

Body Mass ◽

Mean Difference ◽

Obesity Prevalence ◽

Porto Alegre ◽

Measured Weight ◽

Prevalence Of Obesity ◽

The Mean

In order to evaluate the validity of self-reported weight for use in obesity prevalence surveys, self-reported weight was compared to measured weight for 659 adults living in the Porto Alegre county, RS Brazil in 1986-87, both weights being obtained by a technician in the individual's home on the same visit. The mean difference between self-reported and measured weight was small (-0.06 +/- 3.16 kg; mean +/- standard deviation), and the correlation between reported and measured weight was high (r=0.97). Sixty-two percent of participants reported their weight with an error of < 2 kg, 87% with an error of < 4 kg, and 95% with an error of < 6 kg. Underweight individuals overestimated their weight, while obese individuals underestimated theirs (p<0.05). Men tended to overestimate their weight and women underestimate theirs, this difference between sexes being statistically significant (p=0.04). The overall prevalence of underweight (body mass index < 20) by reported weight was 11%, by measured weight 13%; the overall prevalence of obesity (body mass index > 30) by reported weight was 10%, by measured weight 11%. Thus, the validity of reported weight is acceptable for surveys of the prevalence of ponderosity in similar settings.

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A Rapid Motor Task-Based Screening Tool for Parkinsonism in Community-Based Studies

Frontiers in Neurology ◽

10.3389/fneur.2021.653066 ◽

2021 ◽

Vol 12 ◽

Author(s):

Wendy W. Dlamini ◽

Searles Nielsen ◽

Mwiza Ushe ◽

Gill Nelson ◽

Brad A. Racette

Keyword(s):

Standard Deviation ◽

Predictive Model ◽

Screening Tool ◽

Motor Task ◽

Population Based ◽

Validation Dataset ◽

Motor Tasks ◽

Test Dataset ◽

The Mean ◽

Summary Measures

Background: The prevalence of parkinsonism in developing countries is largely unknown due to difficulty in ascertainment because access to neurologists is often limited.Objective: Develop and validate a parkinsonism screening tool using objective motor task-based tests that can be administered by non-clinicians.Methods: In a cross-sectional population-based sample from South Africa, we evaluated 315 adults, age >40, from an Mn-exposed (smelter) community, using the Unified Parkinson Disease Rating Scale motor subsection 3 (UPDRS3), Purdue grooved pegboard, and kinematic-UPDRS3-based motor tasks. In 275 participants (training dataset), we constructed a linear regression model to predict UPDRS3. We selected motor task summary measures independently associated with UPDRS3 (p < 0.05). We validated the model internally in the remaining 40 participants from the manganese-exposed community (test dataset) using the area under the receiver operating characteristic curve (AUC), and externally in another population-based sample of 90 participants from another South African community with only background levels of environmental Mn exposure.Results: The mean UPDRS3 score in participants from the Mn-exposed community was 9.1 in both the training and test datasets (standard deviation = 6.4 and 6.1, respectively). Together, 57 (18.1%) participants in this community had a UPDRS3 ≥ 15, including three with Parkinson's disease. In the non-exposed community, the mean UPDRS3 was 3.9 (standard deviation = 4.3). Three (3.3%) had a UPDRS3 ≥ 15. Grooved pegboard time and mean velocity for hand rotation and finger tapping tasks were strongly associated with UPDRS3. Using these motor task summary measures and age, the UPDRS3 predictive model performed very well. In the test dataset, AUCs were 0.81 (95% CI 0.68, 0.94) and 0.91 (95% CI 0.81, 1.00) for cut points for neurologist-assessed UPDRS3 ≥ 10 and UPDRS3 ≥ 15, respectively. In the external validation dataset, the AUC was 0.85 (95% CI 0.73, 0.97) for UPDRS3 ≥ 10. AUCs were 0.76–0.82 when excluding age.Conclusion: A predictive model based on a series of objective motor tasks performs very well in assessing severity of parkinsonism in both Mn-exposed and non-exposed population-based cohorts.

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A Multicenter Evaluation of an Activated Partial Thromboplastin Time Test, Cepho-Test

10.1055/s-0039-1682491 ◽

1977 ◽

Author(s):

D. Collen ◽

H.C. Godal ◽

P.M. Mannucci ◽

I.M. Nilsson ◽

C. Gilhuus-Moe ◽

...

Keyword(s):

Standard Deviation ◽

Partial Thromboplastin Time ◽

High Sensitivity ◽

Mean Value ◽

Activated Partial Thromboplastin Time ◽

Satisfactory Precision ◽

Time Test ◽

The Mean ◽

Aptt Reagent ◽

Control Plasma

To compare the sensitivity and precision of the Activated Partial Thromboplastin Time (APTT) test Cephotest to that of APTT methods in current use, Cepho-test and current APTT method (Leuven and Milan: Locally modified Thrombofax/kaolin procedures; Malmoe: Automated APTT; Oslo: APTT of human brain/kaolin) were performed in parallel (20 tests) on lyophilized standard plasmas of 4 levels of factors VIII. The mean value (1 standard deviation) of Cephotest on Control Plasma Normal was 36.3 (2.21) s in Leuven, 31.7 (1.13) s in Oslo, 35.0 (1.36) s in Milan and 35.0 (1.16) s in Malmoe. The corresponding values of the local APTT methods were 50.2 (I.58) s, 34.5 (1.27) s, 51.9 (1.17) s and 38.8 (1.23) s, respectively. In Oslo, Milan and Malmoe, the sensitivity of Cephotest was superior to that of the local APTT reagent at all levels of factor VIII. In Leuven, the local APTT method had a higher ratio than Cephotest. There was no statistical significant differences between the standard deviation of Cephotest and the local APTT methods. The study indicates that Cephotest has a high sensitivity, satisfactory precision and is subjected to only minor interlaboratory variations.

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Correlation of STOP-bang obstructive sleep apnoea screening tool to apnoea-hypopnea index in a general cardiology population

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.206 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

J Mannion ◽

W Binalialsharabi ◽

N Caples ◽

M Rogan ◽

S Foley ◽

...

Keyword(s):

Cardiovascular Disease ◽

Standard Deviation ◽

Obstructive Sleep Apnoea ◽

Real World ◽

Screening Tool ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Number Of Patients ◽

Cardiology Clinic ◽

Very High

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The link between obstructive sleep apnoea (OSA) and cardiovascular disease is well known. Prevalence can be very high in this population, sharing many pathophysiological drivers in addition to being a risk factor. More concerning however is the increasing number of patients with undiagnosed OSA, who are at higher risk of long-term complications such as coronary artery disease, hypertension, atrial fibrillation, heart failure or stroke. There are several OSA screening tools available to clinicians, with variable sensitivities and specificities depending on patient demographics. Predictive efficacy of the STOP-Bang screening tool in a general cardiology population with mixed cardiovascular disease has not been established. Proposal To identify the correlation between the STOP-Bang assessment score (1-8) and real-world Apnoea-Hypopnoea Index (AHI) in a general cardiology clinic population. Methods 250 successive patients in a general cardiology clinic were asked to complete a STOP-Bang assessment. Of those, 50 patients with a variety of STOP-Bang scores were randomly selected to undergo sleep studies. A STOP-Bang value of ≥ 5 was taken as high-risk for moderate-severe OSA. Statistical linear regression analysis was performed in IBM SPSS version 26. Results Of n = 50 patients, mean STOP-Bang score =3.7 (SD +/-2.17) with mean AHI =15.8, (SD +/- 14.3). See Table 1 for categories 1-8. N = 44 (88%) had AHI ≥ 5 (At least mild OSA). N = 18 (36%) had an AHI ≥ 15 (Moderate-severe OSA). N = 29 (58%) had symptoms such as sleepiness, loud snoring or witnessed apnoea. Correlation between STOP-Bang score and AHI was high, with an R value of 0.704, R2 = 0.496 (p < 0.01). A STOP-Bang score increase of 1 corresponded with a mean AHI rise of 4.648. When taking a STOP-Bang value of ≥ 5 as "positive", we demonstrated a sensitivity of 83.33% (95% C.I. 58.58-96.42) and specificity of 93.94% (95% C.I. 79.77-99.26%) for moderate-severe OSA (AHI ≥ 15). Conclusion We discovered a very high number of patients with undiagnosed OSA of at least mild severity. We found a strong correlation between STOP-Bang score and real-world AHI in a general cardiology population with mixed cardiovascular disease with 5 as an acceptable screening score for moderate-severe OSA. Table 1 STOP-Bang Value 1 2 3 4 5 6 7 8 Patients (N=) 12 5 7 9 5 5 5 2 AHI (Mean) 6.67 6.62 9.97 11.95 24.44 22.20 39.54 35.25 Standard Deviation (±) 3.29 2.74 3.45 4.63 12.87 5.69 27.2 6.72 Summary of mean apnoea-hypopnoea index and standard deviation for each STOP-Bang patient category. Abstract Figure 1

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Analysis of intensive care admissions among paediatric obstructive sleep apnoea referrals

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0185 ◽

2018 ◽

Vol 100 (1) ◽

pp. 67-71 ◽

Cited By ~ 3

Author(s):

SD Sharma ◽

S Gupta ◽

M Wyatt ◽

D Albert ◽

B Hartley

Keyword(s):

Intensive Care ◽

Sleep Disordered Breathing ◽

Sleep Apnoea ◽

Referral Centre ◽

Nasal Prong ◽

Tertiary Referral ◽

Tertiary Referral Centre ◽

Obstructive Sleep ◽

Nasopharyngeal Airway ◽

The Mean

Introduction The aim of this study was to identify the proportion of children referred to a paediatric tertiary referral centre who required admission to the paediatric intensive care unit (PICU) following surgery for obstructive sleep apnoea (OSA) and to establish risk factors for these admissions. Methods Retrospective review of case notes and the operative database was performed for all children undergoing adenotonsillectomy for sleep disordered breathing and OSA symptoms in Great Ormond Street Hospital over a 10-year period. Results Overall, 1,328 children underwent adenotonsillectomy for sleep disordered breathing and OSA. The mean age was 3.1 years (standard deviation [SD]: 1.7 years). A total of 37 (2.8%) were admitted to the PICU postoperatively (mean length of PICU stay: 1.2 days, standard deviation [SD]: 0.6 days) and 282 (21.2%) required nasopharyngeal airway (nasal prong) insertion intraoperatively. The mean length of stay on the ward following surgery was 1.4 days (SD: 0.8 days). Patients with severe OSA (apnoea–hypopnoea index [AHI] >10) and ASA (American Society of Anesthesiologists) grade ≥3 were more likely to require postoperative PICU admission (22/37 vs 381/1,291 [p<0.001] and 29/37 vs 660/1,291 [p=0.001] respectively). Severe OSA was also more common in children who required nasal prong insertion intraoperatively (186/282 vs 217/1,046, p<0.001). Conclusions Very few children referred to a paediatric tertiary referral centre actually require PICU admission following surgery. This may be in part due to the use of a nasopharyngeal airway in patients where postoperative obstruction is anticipated. In children with severe OSA (AHI >10) and an ASA grade of ≥3, nasopharyngeal airway insertion and potential admission to the PICU should be considered.

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STOP Questionnaire

Anesthesiology ◽

10.1097/aln.0b013e31816d83e4 ◽

2008 ◽

Vol 108 (5) ◽

pp. 812-821 ◽

Cited By ~ 969

Author(s):

Frances Chung ◽

Balaji Yegneswaran ◽

Pu Liao ◽

Sharon A. Chung ◽

Santhira Vairavanathan ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Screening Tool ◽

High Sensitivity ◽

Surgical Patients ◽

Apnea Hypopnea Index ◽

Neck Size ◽

Obstructive Sleep ◽

And Gender ◽

Stop Questionnaire

Background Obstructive sleep apnea (OSA) is a major risk factor for perioperative adverse events. However, no screening tool for OSA has been validated in surgical patients. This study was conducted to develop and validate a concise and easy-to-use questionnaire for OSA screening in surgical patients. Methods After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. After a factor analysis, reliability check, and pilot study; four yes/no questions were used to develop this screening tool. The four questions were respectively related to snoring, tiredness during daytime, observed apnea, and high blood pressure (STOP). For validation, the score from the STOP questionnaire was evaluated versus the apnea-hypopnea index from monitored polysomnography. Results The STOP questionnaire was given to 2,467 patients, 27.5% classified as being at high risk of OSA. Two hundred eleven patients underwent polysomnography, 34 for the pilot test and 177 for validation. In the validation group, the apnea-hypopnea index was 20 +/- 6. The sensitivities of the STOP questionnaire with apnea-hypopnea index greater than 5, greater than 15, and greater than 30 as cutoffs were 65.6, 74.3, and 79.5%, respectively. When incorporating body mass index, age, neck circumference, and gender into the STOP questionnaire, sensitivities were increased to 83.6, 92.9, and 100% with the same apnea-hypopnea index cutoffs. Conclusions The STOP questionnaire is a concise and easy-to-use screening tool for OSA. It has been developed and validated in surgical patients at preoperative clinics. Combined with body mass index, age, neck size, and gender, it had a high sensitivity, especially for patients with moderate to severe OSA.

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Genioglossus advancement and hyoid myotomy: short-term and long-term results

The Journal of Laryngology & Otology ◽

10.1258/002221503321892343 ◽

2003 ◽

Vol 117 (6) ◽

pp. 482-486 ◽

Cited By ~ 46

Author(s):

C. Neruntarat

Keyword(s):

Body Mass Index ◽

Weight Gain ◽

Clinical Success ◽

Sleep Apnoea ◽

Long Term Results ◽

Short Term ◽

Obstructive Sleep ◽

The Mean

Successful results of genioglossus advancement and hyoid myotomy with suspension (GAHM) in the treatment of obstructive sleep apnoea (OSA) have been reported. However, there have been few studies of long-term results. Forty-six patients with hypopharyngeal obstruction underwent GAHM. Patients had a mean age of 40.1 ± 4.2 years and a mean body mass index (BMI) of 28.9 ± 2.1 kg/m2. The mean follow-up was 39.4 ± 5.7 monthswith a range of 37 to 46 months. The mean pre-operative RDI, short-term RDI, and long-term RDI were 47.9 ± 8.4, 14.2 ± 3.9, 18.6 ± 4.1, respectively. The mean post-operative LSAT, short-term LSAT, and long-term LSAT were 81.2 per cent ± 2.9 per cent, 88.8 per cent ± 2.7 per cent and 87.2 per cent ± 3.1 per cent, respectively. The changein BMI was significantly different in the patients with, and without, recurrence (2.1 ± 0.3 vs 0.4 ± 0.2.kg/m2, <0.05). Thirty (65.2 per cent) patientshad long-term clinical success, and six (16.7 per cent) patients with short-term success failedlong-term. GAHM appears to be an effective procedure and results in long-term success. However,patients with weight gain are at risk of recurrence.

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Bedingungen für den Erfolg übergewichtiger und adipöser Kinder in einem ambulanten Programm zur Gewichtsreduktion durch Veränderungen des Lebensstils

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000059 ◽

2010 ◽

Vol 38 (5) ◽

pp. 351-360 ◽

Cited By ~ 1

Author(s):

Wilfried Pott ◽

Georg Fröhlich ◽

Özgür Albayrak ◽

Johannes Hebebrand ◽

Ursula Pauli-Pott

Keyword(s):

Body Mass Index ◽

Standard Deviation ◽

Body Mass ◽

Standard Deviation Score ◽

Psychische Belastung ◽

Deviation Score ◽

Höheres Alter

Fragestellung: Es wurde der Frage nachgegangen, ob sich erfolgreiche Teilnehmer eines ambulanten familienzentrierten Gewichtskontrollprogramms durch spezifische familiäre und psychologische Charakteristiken auszeichnen. Einbezogen wurden die psychosoziale Risikobelastung der Familie, Depressivität und Bindungsstil der Hauptbezugsperson, der Body mass index (BMI) und der BMI-Standardabweichungswert («Standard deviation score», SDS) des teilnehmenden Kindes und der Familienmitglieder sowie die individuelle psychische Belastung des teilnehmenden Kindes. Methodik: Die Daten wurden per Interview und Fragebogen vor dem Behandlungsbeginn erhoben. Von 136 in das Programm aufgenommenen übergewichtigen und adipösen Kindern zwischen 7 und 15 Jahren beendeten 116 das 12-monatige Interventionsprogramm. Von diesen zeigten 100 (85,3 %) eine Reduktion des BMI-SDS und 79 (68.1 %) eine mehr als 5 %ige Reduktion des BMI-SDS. Diese «erfolgreichen» Kinder wurden mit 56 «nicht erfolgreichen» (Abbrecher und Kinder mit einer 5 %igen oder geringeren Reduktion des BMI-SDS) verglichen. Ergebnisse: Nicht erfolgreiche Kinder unterschieden sich von den erfolgreichen durch ein höheres Alter, eine höhere psychosoziale Risikobelastung, Depressivität und einen vermeidenden Bindungsstil der Mutter sowie durch das Vorhandensein adipöser Geschwister. In einer logistischen Regressionsanalyse zeigten sich mütterliche Depressivität und das Vorhandensein adipöser Geschwister als beste und voneinander unabhängige Prädiktoren. Schlussfolgerungen: Um die spezifischen Bedürfnisse der Familien zu erfüllen und einen Misserfolg zu verhindern, sollten zusätzliche Programmbausteine zur spezifischen Unterstützung von Jugendlichen mit adipösen Geschwistern und Müttern mit Depressionen und vermeidenden Bindungsstil entwickelt werden. Die Wirksamkeit dieser Module muss dann in weiteren Studien überprüft werden.

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