scholarly journals Usefulness of different screening questionnaires and scoring systems for obstructive sleep apnea in patients with atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Delesie ◽  
L Knaepen ◽  
A Wouters ◽  
A De Cauwer ◽  
A De Roy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Gold Standard ◽  
Scoring Systems ◽  
Public Institution ◽  
Screening Tools ◽  
Berlin Questionnaire ◽  
Obstructive Sleep ◽  
Screening Questionnaires

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This study is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. OnBehalf Research Group Cardiovascular Diseases, University of Antwerp Background Obstructive sleep apnea (OSA) influences the progression of atrial fibrillation (AF) but is underdiagnosed in this population. Studies have shown that its treatment can help to reduce AF recurrences and improve symptoms. Polysomnography (PSG) is currently the gold standard for diagnosing OSA but being expensive and requiring overnight examination it is therefore not the ideal screening method. Different OSA screening tools such as questionnaires and scoring systems already exist but their value in AF patients remains unclear. Purpose The aim of this study was to examine the performance of different screening questionnaires and scoring systems for diagnosing OSA in an AF cohort, compared with PSG as gold standard. Methods Prospective study of the predictive performance of seven screening questionnaires and scoring systems (the Epworth Sleepiness Scale (ESS), the Berlin Questionnaire (BQ), Sleep Apnea Clinical Score (SACS), OSA50, STOP-BANG, NoSAS, MOODS) in consecutive AF patients referred to two sleep clinics. Results A total of 100 AF patients presenting for PSG were included (64.0 ± 8.6 years, 73% male, 87% non-permanent AF, mean Body Mass Index 30.6 ± 5.9 kg/m2, mean CHA2DS2-VASc score 2.4 ± 1.7, mEHRA≥2 in 64%; mean AF history 5.4 ± 5.6 years).  Forty-two percent of patients were referred to the sleep clinic by cardiologists. PSG diagnosed ≥mild OSA in 90% of patients, ≥moderate in 69%, and severe OSA in 33%. In screening for mild OSA, NoSAS, STOP-BANG and MOODS screening questionnaires had a fair area under the curve (AUC) of 0.773, 0.710 and 0.709 respectively. For at least moderate OSA, only the SACS and the NoSAS questionnaires had an AUC of 0.704 and 0.712 respectively (Figure 1). None of the seven screening questionnaires/scoring systems were performant enough (i.e. a fair AUC > 0.7) to detect severe OSA. Conclusions Our analysis shows that screening questionnaires and scoring systems such as ESS, BQ, SACS, NoSAS, OSA50, STOP-BANG and MOODS are not very useful to predict clinically relevant OSA (i.e. at least moderate OSA) in AF patients. Therefore, other screening modalities for OSA in AF patients should be investigated and validated. Abstract Figure 1

scholarly journals Cardiorespiratory Polygraphy for Detection of Obstructive Sleep Apnea in Patients With Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Michiel Delesie ◽  
Lieselotte Knaepen ◽  
Johan Verbraecken ◽  
Karolien Weytjens ◽  
Paul Dendale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Screening Tool ◽  
Area Under The Curve ◽  
Screening Tools ◽  
Apnea Hypopnea Index ◽  
Automated Algorithm ◽  
Obstructive Sleep ◽  
At Home

Background: Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients due to absence of good OSA screening pathways. Polysomnography (PSG) is the gold standard for diagnosing OSA but too resource-intensive as a screening tool. We explored whether cardiorespiratory polygraphy (PG) devices using an automated algorithm for Apnea-Hypopnea Index (AHI) determination can meet the requirements of a good screening tool in AF patients.Methods: This prospective study validated the performance of three PGs [ApneaLink Air (ALA), SOMNOtouch RESP (STR) and SpiderSAS (SpS)] in consecutive AF patients who were referred for PSG evaluation. Patients wore one of the three PGs simultaneously with PSG, and a different PG during each of three consecutive nights at home. Severity of OSA was classified according to the AHI during PSG (<5 = no OSA, 5–14 = mild, 15–30 = moderate, >30 = severe).Results: Of the 100 included AF patients, PSG diagnosed at least moderate in 69% and severe OSA in 33%. Successful PG execution at home was obtained in 79.1, 80.2 and 86.8% of patients with the ALA, STR and SpS, respectively. For the detection of clinically relevant OSA (AHI ≥ 15), an area under the curve of 0.802, 0.772 and 0.803 was calculated for the ALA, STR and SpS, respectively.Conclusions: This study indicates that home-worn PGs with an automated AHI algorithm can be used as OSA screening tools in AF patients. Based on an appropriate AHI cut-off value for each PG, the device can guide referral for definite PSG diagnosis.

The importance of screening questionnaires in detecting the severity of obstructive sleep apnea

2021 ◽  
Vol 70 (2) ◽  
pp. 75-81
Author(s):  
Šárka Solecká ◽  
Jan Betka ◽  
Karel Matler ◽  
Hana Tomášková
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pittsburgh Sleep Quality Index ◽  
Neck Circumference ◽  
Berlin Questionnaire ◽  
Hip Circumference ◽  
Obstructive Sleep ◽  
Screening Questionnaires ◽  
Stop Questionnaire

ntroduction: The aim of this study is to compare the importance of screening questionnaires and risk factors in detecting the severity of obstructive sleep apnea (OSA). Methods: The study included 47 patients with suspected OSA. The patients completed 5 screening questionnaires – the Epworth Sleepiness Scale (ESS), the STOP BANG questionnaire, the STOP questionnaire, the Berlin questionnaire (BQ) and the Pittsburgh Sleep Quality Index (PSQI). Subsequently, they were examined by the limited polygraphy. AHI (number of apneas/ hypopneas per 1 hour), t90 desaturation (percentage of sleep time spent in desaturations below 90%) and ODI (number of desaturations ≥ 3% within 1 hour) were compared with questionnaire scores and selected risk factors for OSA (BMI, male gender, hypertension, age, neck circumference, abdominal circumference and abdominal/ hip circumference ratio). Results: The achieved score of any of the monitored questionnaires does not correlate with the value of AHI. BQ, STOP and STOP BANG questionnaires have the relatively highest sensitivity for OSA detection, while the sensitivity of PSQI and ESS is low. The correlation of the ESS, STOP BANG and BQ scores with the t90 desaturation, as well as the ESS and STOP BANG scores with the ODI is statistically signifi cant. The relationship of any of the selected risk factors with the AHI value has not been demonstrated. Desaturation values of t90 and ODI correlated best with BMI, neck circumference and abdominal/ hip circumference ratio. Conclusion: None of the monitored questionnaires is suitable for determining the severity of OSA, it is always necessary to perform a polygraphic or polysomnographic examination of sleep. BQ and STOPBANG are relatively most suitable for OSA screening. They both have high sensitivity and, at the same time, their score correlates with the value of nocturnal hypoxemia. Parameters measuring nocturnal hypoxemia (t90 desaturation, ODI) correlate better with risk factors than AHI. The most important parameters associated with hypoxemia are BMI, neck circumference and abdominal/ hip circumference ratio and it is appropriate to include them in the screening for OSA. Keywords: obstructive sleep apnea – Berlin questionnaire – STOP-Bang questionnaire – STOP questionnaire – Epworth sleepiness scale – Pittsburgh Sleep Quality Index

Clinical screening tools for obstructive sleep apnea in a population with atrial fibrillation: a diagnostic accuracy trial

2021 ◽  
Author(s):  
Anna M. Mohammadieh ◽  
Kate Sutherland ◽  
Logan B. Kanagaratnam ◽  
David W. Whalley ◽  
Mark J. Gillett ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Diagnostic Accuracy ◽  
Screening Tools ◽  
Clinical Screening ◽  
Obstructive Sleep

Abstract W P224: SOS Score: an Optimized Score to Screen Acute Stroke Patients for Obstructive Sleep Apnea

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Millene R Camilo ◽  
Heidi H Sander ◽  
Alan L Eckeli ◽  
Regina M Fernandes ◽  
Taiza E Santos-Pontelli ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Acute Stroke ◽  
Predictive Value ◽  
Screening Tools ◽  
Berlin Questionnaire ◽  
Stroke Patients ◽  
Obstructive Sleep ◽  
The Mean

Background: Obstructive sleep apnea (OSA) is frequent in acute stroke patients and is associated with increased mortality and poor functional outcome. Polysomnography (PSG) is the gold standard diagnostic method for OSA, but it is impracticable as a routine for all acute stroke patients. We evaluated how OSA screening tools such as the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS) would perform when administered to relatives of stroke patients in the acute setting, and compared these individual tools against a combined screening score (SOS score). Methods: Ischemic stroke patients were submitted to a full PSG at the first night after symptoms onset. OSA severity was measured by apnea-hypopnea index (AHI). BQ and ESS were administered to relatives of stroke patients before the PSG. We combined elements of the BQ and ESS to create a new screening tool for OSA named Sleep Obstructive apnea score optimized for Stroke (SOS score). Results: Thirty-nine consecutives ischemic stroke patients were enrolled in our study. The mean age was 62.3 ±12.2 years. Age was significantly different between those with and without OSA (p=0.02). The mean body mass index and neck circumference were 26.7 ± 4.7 and 38.9 ± 4.0cm, respectively. OSA (AHI ≥ 10) was present in 76.9%. The area under the curve for SOS score (AUC:0.812; p=0.005) was superior to BQ (AUC:0.567; p=0.549) and also to ESS (AUC:0.646; p=0.119 vs. AUC:0.686; p=0.048) for severe OSA (IAH ≥ 30). The threshold of SOS ≤ 10 (present in 20.5% of patients) showed high sensitivity (90%) and negative predictive value (96.2%) for OSA; SOS ≥20 (17.9% of patients) showed high specificity (100%) and positive predictive value (92.5%) for severe OSA. Using SOS as a screening approach would decrease by around 40% the demand for PSG during the acute stroke setting. Conclusions: The SOS score when administered to relatives of stroke patients appears to be an appropriate tool to screen acute stroke patients for OSA, while decreasing the need for a formal sleep study during the acute stroke setting. The new derived SOS score is superior to BQ and ESS for identifying patients with OSA and Severe OSA during the acute phase of stroke.

Abstract 41: Stroke Unit Evaluation of Sleep Apnea: Validity of Screening Tools and Use of a Portable Sleep Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hugo J Aparicio ◽  
Tudor Sturzoiu ◽  
Helena W Lau ◽  
Judith Clark ◽  
Julie Grimes ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Stroke Unit ◽  
Central Sleep Apnea ◽  
Screening Tools ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Validity And Reliability ◽  
Sleep Study ◽  
Obstructive Sleep

Background: Despite high prevalence in the stroke population, sleep apnea is underdiagnosed. Obstructive sleep apnea is associated with poor cardiovascular outcomes and treatment with continuous positive airway pressure has been shown to lower blood pressure. No standard exists for screening patients who present to the hospital with acute stroke. We assessed three screening tools, the Epworth Sleepiness Scale (ESS), Berlin Questionnaire (BQ), and STOP-BANG Questionnaire (STOP-BANG), along with the use of a portable sleep study device for evaluation of sleep apnea. Overnight polysomnography (PSG) was performed on a subset of patients on outpatient follow up. Methods: Patients admitted to the stroke unit at our hospital, over nine months, were screened for sleep apnea using the three instruments, ESS, BQ, and STOP-BANG. The patients were evaluated with a portable sleep study device, ApneaLink Air (ResMed, USA), prior to discharge. Respiratory effort, respiratory flow, pulse oximetry, and oxygen saturation were recorded and sleep apnea was determined by apnea-hypopnea index (AHI) ≥ 5. Predictions from the screening tools were compared to the portable sleep study and overnight PSG results. Sensitivity and specificity testing were used to assess the validity and reliability of the tools. Results: Sleep questionnaires were administered on 37 patients who underwent an overnight sleep study. Portable studies were used to evaluate 33 patients, and 13 PSGs were performed. Obstructive sleep apnea was diagnosed in 20 (69%) and central sleep apnea in 9 (31%). Cheyne-Stokes pattern breathing was observed in 2 (5%). Mean AHI was 18.3 + 21.8/hr and maximum AHI was 105.8/hr. Sensitivity for the ESS, BQ, and STOP-BANG were 0.39, 0.66, and 0.83 and specificity for these tools were 0.26, 0.33, and 0.29, respectively. In patients who underwent the portable sleep study and overnight PSG, 9/10 (90%) of the studies were concordant. Conclusions: The STOP-BANG questionnaire, administered to hospitalized stroke patients, had high sensitivity and low-moderate specificity in our study, compared to two other commonly used screening tools. Further, the feasibility of using an unattended inpatient portable sleep study on stroke inpatients is demonstrated.

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