Use of Berlin questionnaire in comparison to polysomnography and home sleep study in patients with obstructive sleep apnea

Abstract Study Objectives Polysomnography is the gold standard for diagnosis of obstructive sleep apnea (OSA) but it is costly and access is often limited. The aim of this study is to develop a clinically useful support vector machine (SVM)-based prediction model to identify patients with high probability of OSA for nonsleep specialist physician in clinical practice. Methods The SVM model was developed using the features routinely collected at the clinical evaluation from 6,875 Chinese patients referred to sleep clinics for suspected OSA. Three apnea-hypopnea index (AHI) cutoffs, ≥5/h, ≥15/h, and ≥30/h were used to define the severity of OSA. The continuous and categorized features were selected separately and were further selected through stepwise forward feature selection. The modeling was achieved through fivefold cross-validation. The model discriminative ability was evaluated for the whole data set and four subgroups categorized with gender and age (<65 versus ≥65 years old [y/o]). Results Two features were selected to predict AHI cutoff ≥5/h with six features selected for ≥15/h, and six features selected for ≥30/h, respectively, to reach Area under the Receiver Operating Characteristic (AUROC) 0.82, 0.80, and 0.78, respectively. The sensitivity was 74.14%, 75.18%, and 70.26%, while the specificity was 74.71%, 68.73%, and 70.30%, respectively. Compared to logistic regression, Berlin questionnaire, NoSAS Score, and Supersparse Linear Integer Model (SLIM) scoring system, the SVM model performs better with a more balanced sensitivity and specificity. The discriminative ability was best for male <65 y/o and modest for female ≥65 y/o. Conclusion Our model provides a simple and accurate modality for early identification of patients with OSA and may potentially help prioritize them for sleep study.

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Revisiting level II sleep studies in the era of COVID-19: a theoretical economic decision model in patients with suspected obstructive sleep apnea

Sleep Science and Practice ◽

10.1186/s41606-021-00063-5 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Najib T. Ayas ◽

Rachel Jen ◽

Brett Baumann

Keyword(s):

British Columbia ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Decision Model ◽

Sleep Study ◽

Diagnostic Algorithms ◽

Sleep Studies ◽

Level Ii ◽

Obstructive Sleep ◽

Home Sleep Study

Abstract Background The recent pandemic has made it more challenging to assess patients with suspected obstructive sleep apnea (OSA) with in laboratory polysomnography (PSG) due to concerns of patient and staff safety. The purpose of this study was to assess how Level II sleep studies (LII, full PSG in the home) might be utilized in diagnostic algorithms of suspected OSA using a theoretical decision model. Methods We examined four diagnostic algorithms for suspected OSA: an initial PSG approach, an initial LII approach, an initial Level III approach (LIII, limited channel home sleep study) followed by PSG if needed, and an initial LIII approach followed by LII if needed. Costs per patient assessed was calculated as a function of pretest OSA probability and a variety of other variables (e.g. costs of tests, failure rate of LIII/LII, sensitivity/specificity of LIII). The situation in British Columbia was used as a case study. Results The variation in cost per test was calculated for each algorithm as a function of the above variables. For British Columbia, initial LII was the least costly across a broad range of pretest OSA probabilities (< 0.80) while initial LIII followed by LII as needed was least costly at very high pretest probability (> 0.8). In patients with a pretest OSA probability of 0.5, costs per patient for initial PSG, initial LII, initial LIII followed by PSG, and initial LIII followed by LII were: $588, $417, $607, and $481 respectively. Conclusions Using a theoretical decision model, we developed a preliminary cost framework to assess the potential role of LII studies in OSA assessment. Across a broad range of patient pretest probabilities, initial LII studies may provide substantial cost advantages. LII studies might be especially useful during pandemics as they combine the extensive physiologic information characteristic of PSG with the ability to avoid in-laboratory stays. More empiric studies need to be done to test these different algorithms.

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864 New-onset Obstructive Sleep Apnea Diagnosis in a COVID-positive Patient

SLEEP ◽

10.1093/sleep/zsab072.861 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A336-A336

Author(s):

Nobel Nguyen ◽

Kimberly Mebust

Keyword(s):

Risk Factors ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Family History ◽

Oxygen Saturation ◽

Sleep Study ◽

Obstructive Sleep ◽

Study Results ◽

Home Sleep Study ◽

New Onset

Abstract Introduction Risk factors for the mortality of COVID-19, such as cardiovascular and lung disease, are commonly seen in patients with obstructive sleep apnea (OSA). Patients with OSA experience approximately 8-fold greater risk for COVID-19 infection compared to a similar age population. Among patients with COVID-19 infection, OSA was associated with an increased risk of hospitalization and approximately doubled the risk of developing respiratory failure. However, there is little information on whether COVID-19 can directly develop OSA. To the best of our knowledge, we describe the first case-presentation of a positive COVID-19 patient who developed sudden-onset OSA. Report of case(s) NL is a 47-year-old female who complains of new-onset snoring, excessive daytime sleepiness, and witnessed apnea events after testing positive for COVID-19 seven months prior after developing mild symptoms. Her ESS score is 12/24, neck circumference is 14.75 cm, BMI is 27.9, and Mallampati II. She has no pertinent PMH and is not a tobacco user. In regards to her sleep, she has no symptoms of restless legs, narcolepsy, or periodic limb movements. She denies any physical disturbances, psychiatric conditions, environmental factors, or medical issues that might affect her sleep. There is no family history of sleep apnea, snoring, or other sleeping disorders. The patient's presentation at the initial sleep visit prompted a home sleep study. Results of her home sleep study revealed 131 total number of sleep-related respiratory events, with an apnea-hypopnea index of 11.9 per hour. Mean oxygen saturation was 94% and the minimum oxygen saturation was 83%. Total estimated sleep time was 7 hours, 59 mins, and sleep quality and duration were deemed adequate. The results from NL's sleep study gave the final diagnosis of mild OSA. Conclusion Besides having a slightly overweight BMI, NL had relatively few risk factors for developing OSA (no family history, no comorbidities, and normal physical exam findings). The link between the virus and the development of OSA in healthy individuals is not readily apparent. We recommend sleep studies for healthy patients who develop OSA like-symptoms after being infected with COVID-19 to prevent unwanted health risks associated with OSA. Support (if any):

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Gender Differences in Obstructive Sleep Apnea: The Value of Sleep Questionnaires with a Separate Analysis of Cardiovascular Patients

Journal of Clinical Medicine ◽

10.3390/jcm9010130 ◽

2020 ◽

Vol 9 (1) ◽

pp. 130 ◽

Cited By ~ 1

Author(s):

Athanasia Pataka ◽

Seraphim Kotoulas ◽

George Kalamaras ◽

Sofia Schiza ◽

Konstantinos Sapalidis ◽

...

Keyword(s):

Gender Differences ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Berlin Questionnaire ◽

Separate Analysis ◽

Sleep Study ◽

Predictive Values ◽

Athens Insomnia Scale ◽

Obstructive Sleep ◽

Sleep Questionnaires

Background: Gender affects the clinical presentation of obstructive sleep apnea (OSA). The classic OSA symptoms, such as sleepiness, snoring, and apnea, are not so frequent in women. Objectives: To evaluate possible gender differences in questionnaires used for OSA prediction, such as the Epworth Sleepiness Scale (ESS), STOP, STOP Bang (SB), Berlin Questionnaire (BQ), Athens Insomnia Scale (AIS), and Fatigue Scale (FS). Methods: 350 males were matched with 350 women referred to a sleep clinic, according to OSA severity. All responded to the questionnaires and underwent a sleep study. Cardiovascular disease (CVD) patients were separately analyzed. Results: ESS did not differ between genders. SB was higher in males, whereas STOP, BQ, AIS, and FS were higher in females. BQ presented the highest sensitivity in both genders, whereas STOP exhibited the highest specificity in males and ESS in females. AIS and FS were more sensitive and SB more specific in females, whereas BQ was more specific in males. For severe OSA, the predictive values of SB and BQ were almost similar for both genders; however AIS and FS were higher in women. CVD patients presented higher scores, independent of gender, except for AIS, which was higher in females. Conclusion: Gender-specific evaluation of questionnaires is necessary to prevent OSA under-diagnosis.

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Home sleep study equivalent to conventional sleep study in most patients with suspected obstructive sleep apnea

Evidence-Based Practice ◽

10.1097/ebp.0000000000000635 ◽

2020 ◽

Vol 23 (9) ◽

pp. 4-4

Author(s):

E. Ashley Suniega ◽

Christina Thoma

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Study ◽

Obstructive Sleep ◽

Home Sleep Study

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

Stroke ◽

10.1161/str.47.suppl_1.41 ◽

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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Faculty Opinions recommendation of Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727144766.793544466 ◽

2018 ◽

Author(s):

Frances Chung

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Diagnostic Accuracy ◽

Epworth Sleepiness Scale ◽

Meta Analysis ◽

Berlin Questionnaire ◽

Obstructive Sleep

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