scholarly journals Association of Obstructive Sleep Apnea and severity of COVID-19: A hospital based observational study

Author(s):  
Avishek Kar ◽  
Khushboo Saxena ◽  
Abhishek Goyal ◽  
Abhijit Pakhare ◽  
Alkesh Khurana ◽  
...  

AbstractIntroductionOSA has been postulated to be associated with mortality in COVID19, but studies are lacking thereof. This study was done to estimate prevalence of OSA in patients with COVID-19 using various screening questionnaires and to assess effect of OSA on outcome of disease.MethodologyIn this prospective observational study, consecutive patients with RTPCR confirmed COVID 19 patients were screened for OSA by different questionnaires (STOPBANG, Berlin Questionnaire, NoSAS and Epworth Scale). Association between OSA and outcome (mortality) and requirement for respiratory support was assessed.ResultsIn study of 213 patients; screening questionnaires for OSA {STOPBANG, Berlin Questionnaire (BQ), NoSAS} were more likely to be positive in patients who died compared to patients who survived. On binary logistic yregression analysis, age≥55 and STOPBANG score ≥5 were found to have small positive but independent effect on mortality even after adjusting for other variables. Proportion of patients who were classified as high risk for OSA by various OSA screening tools significantly increased with increasing respiratory support (p<0.001 for STOPBANG, BQ, ESS and p=0.004 for NoSAS).ConclusionThis is one of the first prospective studies of sequentially hospitalized patients with confirmed COVID 19 status who were screened for possible OSA. This study shows that OSA could be an independent risk factor for poor outcome in patients with COVID19.

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Delesie ◽  
L Knaepen ◽  
A Wouters ◽  
A De Cauwer ◽  
A De Roy ◽  
...  

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 &gt; 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


2008 ◽  
Vol 108 (5) ◽  
pp. 822-830 ◽  
Author(s):  
Frances Chung ◽  
Balaji Yegneswaran ◽  
Pu Liao ◽  
Sharon A. Chung ◽  
Santhira Vairavanathan ◽  
...  

Background Because of the high prevalence of obstructive sleep apnea (OSA) and its adverse impact on perioperative outcome, a practical screening tool for surgical patients is required. This study was conducted to validate the Berlin questionnaire and the American Society of Anesthesiologists (ASA) checklist in surgical patients and to compare them with the STOP questionnaire. Methods After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. The scores from the Berlin questionnaire, ASA checklist, and STOP questionnaire were evaluated versus the apnea-hypopnea index from in-laboratory polysomnography. The perioperative data were collected through chart review. Results Of 2,467 screened patients, 33, 27, and 28% were respectively classified as being at high risk of OSA by the Berlin questionnaire, ASA checklist, and STOP questionnaire. The performance of the screening tools was evaluated in 177 patients who underwent polysomnography. The sensitivities of the Berlin questionnaire, ASA checklist, and STOP questionnaire were 68.9-87.2, 72.1-87.2, and 65.6-79.5% at different apnea-hypopnea index cutoffs. There was no significant difference between the three screening tools in the predictive parameters. The patients with an apnea-hypopnea index greater than 5 and the patients identified as being at high risk of OSA by the STOP questionnaire or ASA checklist had a significantly increased incidence of postoperative complications. Conclusions Similar to the STOP questionnaire, the Berlin questionnaire and ASA checklist demonstrated a moderately high level of sensitivity for OSA screening. The STOP questionnaire and the ASA checklist were able to identify the patients who were likely to develop postoperative complications.


2021 ◽  
Vol 70 (2) ◽  
pp. 75-81
Author(s):  
Šárka Solecká ◽  
Jan Betka ◽  
Karel Matler ◽  
Hana Tomášková

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


Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Millene R Camilo ◽  
Heidi H Sander ◽  
Alan L Eckeli ◽  
Regina M Fernandes ◽  
Taiza E Santos-Pontelli ◽  
...  

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.


Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hugo J Aparicio ◽  
Tudor Sturzoiu ◽  
Helena W Lau ◽  
Judith Clark ◽  
Julie Grimes ◽  
...  

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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