Validity of the STOP-Bang Questionnaire in Identifying OSA in a Dental Patient Cohort

Background and objectives: Obstructive Sleep Apnea represents a widespread problem in the population, but it is often not diagnosed and not considered a true pathology. Different diagnostic tools are available for the diagnosis of sleep apnea. This study aims to demonstrate the ability of the STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) questionnaire in identifying subjects with Obstructive Sleep Apnea (OSA) Syndrome, highlighting the role of dentists as epidemiological sentinels. Materials and methods: the STOP-Bang questionnaire was administered to a cohort of 1000 patients, assessing three private dental clinics in Italy. Excessive daytime sleepiness was measured using Epworth Sleepiness Scale (ESS) and defined as ≥ 10. Subjects were considered at risk of OSA if they had three or more positive items at STOP-Bang and were invited to undergo further examination with a type 3 polygraph. Presence of OSA was measured with the apnea-hypopnea index (AHI) and defined as AHI ≥ 5. Results: 482/1000 subjects (48.2%) had three or more positive items in the STOP-Bang questionnaire and were considered at risk for Obstructive Sleep Apnea Syndrome (OSAS). Excessive daytime sleepiness (EDS ≥ 10) was more frequent among subjects at risk for OSAS (73/482, 15.1%) vs. those not at risk for OSAS (30/518, 5.8%) (p < 0.0001). Moreover, 153/482 subjects at risk for OSAS (31.7%) accepted further examination with a type 3 polygraph. Presence of OSAS (AHI ≥ 5) was suggested in 121/153 subjects (79.1%, 95% CI 71.6% to 85.1%), with 76/121 subjects (62.8%) needing treatment (AHI ≥ 15). Conclusion: the high prevalence of OSAS highlights the role of dentists as “epidemiological sentinels”. The STOP-Bang questionnaire is a simple and efficacious instrument for screening sleep apnea patients.

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The role of home sleep testing for evaluation of patients with excessive daytime sleepiness: focus on obstructive sleep apnea and narcolepsy

Sleep Medicine ◽

10.1016/j.sleep.2019.01.014 ◽

2019 ◽

Vol 56 ◽

pp. 80-89 ◽

Cited By ~ 3

Author(s):

Russell Rosenberg ◽

Max Hirshkowitz ◽

David M. Rapoport ◽

Meir Kryger

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Home Sleep Testing ◽

Obstructive Sleep

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Clinical Features and Contributing Factors of Excessive Daytime Sleepiness in Chinese Obstructive Sleep Apnea Patients: The Role of Comorbid Symptoms and Polysomnographic Variables

Canadian Respiratory Journal ◽

10.1155/2019/5476372 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Chuan Shao ◽

Huan Qi ◽

Ruyi Lang ◽

Biyun Yu ◽

Yaodong Tang ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Clinical Features ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Memory Loss ◽

Apnea Hypopnea Index ◽

Contributing Factors ◽

Obstructive Sleep ◽

Work Commute

Background. The occurrence and severity of excessive daytime sleepiness (EDS) vary considerably among obstructive sleep apnea (OSA) patients. This study was designed to investigate the characteristics of EDS and identify its contributing factors in OSA patients. Methods. This was a cross-sectional study from a tertiary medical center in China. A total of 874 consecutive patients with newly diagnosed OSA were included. Subjective daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). The subjects were assigned to the non-EDS group (582 patients), mild to moderate EDS group (227 patients), and severe EDS group (65 patients) according to the ESS scores. The clinical features and polysomnographic parameters were acquired and analyzed to identify the differences between groups and the determinants of EDS. Results. The age of patients with severe EDS (49.5 ± 11.3) was slightly greater than that of patients with mild to moderate EDS (44.5 ± 10.2) (p<0.05) and non-EDS patients (45.2 ± 12.0) (p<0.05). Body mass index (BMI) was highest in the severe EDS group (29.1 ± 3.6 kg/m2) (p<0.0001), intermediate in the mild to moderate EDS group (27.9 ± 3.3 kg/m2), and lower in the non-EDS group (26.8 ± 3.3 kg/m2). Logistic regression analysis showed waist circumference, memory loss, work/commute disturbances, and sleep efficiency were independently associated with mild to moderate EDS, and the microarousal index, apnea-hypopnea index (AHI), and saturation impair time below 90% were independent contributing factors of mild to moderate EDS. Meanwhile, age, neck circumference, gasping/choking, memory loss, work/commute disturbances, and sleep latency were independently associated with severe EDS, and the AHI and mean SpO2 were independent contributing factors of severe EDS. Conclusions. OSA patients with various severities of EDS are more obese and have more comorbid symptoms compared to patients without EDS. Sleep fragmentation, respiratory events, and nocturnal hypoxia may be predictors of EDS. Comprehensive consideration of demographic, clinical, and polysomnographic factors is required when evaluating OSA patients.

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Prevalence of Obstructive Sleep Apnea in Patients With Acute Stroke

Journal of Stroke Medicine ◽

10.1177/2516608519870702 ◽

2019 ◽

Vol 2 (2) ◽

pp. 128-135

Author(s):

Mantha Satya Padmaja ◽

Uma Maheswari Krishnaswamy ◽

Mahendra V. Javali

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Acute Stroke ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Apnea Hypopnea Index ◽

Stroke Severity ◽

Stroke Patients ◽

Obstructive Sleep ◽

Level 3

Background: Obstructive sleep apnea (OSA) is an eminently modifiable and emerging risk factor for acute stroke. This prospective study was conducted in a tertiary care center to estimate the proportion of OSA in patients presenting with acute stroke. Materials and Methods: Consecutive stable patients with acute stroke were included. Stroke severity, subtype, and anatomical location were classified using standardized scales. Included subjects were screened for OSA with a detailed history (intrusive snoring, witnessed apneas, and excessive daytime sleepiness), quantification of sleepiness (Epworth Sleepiness Scale), clinical examination, and level-3 polysomnography. OSA severity was quantified based on the Apnea–Hypopnea Index. Results: 104 clinically stable stroke patients (67 males and 37 females) were included in the study; mean age was 60.9±13.2 years. Most patients (92 [88.5%]) had ischemic stroke, 9 (8.7%) had hemorrhagic stroke, and 3 (2.9%) had a transient ischemic attack. Intrusive snoring was reported by 37 (35.6%) patients, excessive daytime sleepiness by 32 (30.8%) and witnessed apneas by 19 (18.3%) patients. On level-3 polysomnography, 74 (71.2%) patients were diagnosed to have OSA. Mild OSA was diagnosed in 34 patients, while moderate and severe OSA were diagnosed in 20 patients each. Conclusions: Our study has demonstrated a strong causal relationship between OSA and stroke, thus reinforcing the need to screen all patients with stroke for OSA. Timely institution of nocturnal noninvasive ventilation in stroke patients with OSA would help to reduce the effects of OSA on stroke morbidity and recurrence.

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Contributing Factors of Excessive Daytime Sleepiness in Morbid Obese Patients with Obstructive Sleep Apnea

Journal of the Korean Neurological Association ◽

10.17340/jkna.2021.4.5 ◽

2021 ◽

Vol 39 (4) ◽

pp. 298-304

Author(s):

Sangil Park ◽

Jung-Ick Byun ◽

Sun-Min Yoon ◽

Seungmin Lee ◽

Kunwoo Park ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Odds Ratio ◽

Apnea Hypopnea Index ◽

Obese Patients ◽

Obstructive Sleep ◽

Morbid Obese ◽

Insomnia Severity

Background: Obesity, obstructive sleep apnea (OSA), and excessive daytime sleepiness (EDS) are common conditions and are interrelated. Obesity is a risk factor for OSA and independently associated with EDS. We aimed to evaluate frequency of EDS in morbid obese patients with OSA and to identify contribution factor for EDS.Methods: This was a retrospective cross-sectional study in single sleep center. Consecutive patients with OSA (with apnea-hypopnea index 5/h or more) with morbid obesity (body mass index over 35 kg/m2) was enrolled. EDS were defined as Epworth Sleepiness Scale of 10 points or more. Clinical and polysomnographic variables were compared between those with and without EDS.Results: Total 110 morbid obese patients with OSA were enrolled, and 34 (31%) of them had EDS. Those with EDS had higher subjective symptom of insomnia and depression. Rapid eye movement sleep latency was shorter and minimum saturation was lower for those with EDS. Multivariate logistic regression analysis identified insomnia severity (odds ratio, 1.117) and minimum saturation (odds ratio, 0.952) as independent contribution factor for EDS.Conclusions: Result of this study suggest that 31.4% of morbid obese patients with OSA have EDS, and it can be affected by insomnia severity and desaturation during sleep.

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Obstructive sleep apnea is prevalent in patients with pulmonary embolism

Clinical & Investigative Medicine ◽

10.25011/cim.v36i6.20624 ◽

2013 ◽

Vol 36 (6) ◽

pp. 277 ◽

Cited By ~ 9

Author(s):

Deniz Kosovalı ◽

Meral Uyar ◽

Osman Elbek ◽

Nazan Bayram ◽

İlker Özsaraç ◽

...

Keyword(s):

Pulmonary Embolism ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Sleep Stage ◽

Control Group ◽

Apnea Hypopnea Index ◽

Study Group ◽

Obstructive Sleep

Purpose: Obstructive sleep apnea (OSA) syndrome causes systemic consequences due to hypoxia and endothelial dysfunction. The purpose of this study was to investigate whether OSA is more common in subjects with pulmonary embolism (PE). Methods: This prospective study was conducted between November 2009 and December 2010 in the Department of Pulmonary Medicine of Gaziantep University. Twenty-eight patients with PE were included in the study group along with forty-five subjects with OSA as the control group. The control group was selected from among subjects who were referred to the sleep clinic. Full night polysomnography was performed for each subject. Results: Mean apnea-hypopnea index (AHI) was found to be higher in the PE group compared with the control group (p=0.010). Severe OSA was detected in 21.4% of the PE group but in no controls (p=0.015). Sleep stage 2 was longer in control group whereas stage 1 and rapid eye movement (REM) sleep was longer in the PE group. Snoring and excessive daytime sleepiness were more common in the control group compared with the study group. AHI severity and thrombus localization were not significantly different between the groups (p=0.350). Conclusion: Our study findings suggest that OSA is more prevalent and severe in subjects with PE compared with control subjects. The clinical significance of less prevalent excessive daytime sleepiness and snoring in subjects with PE should be evaluated in further studies.

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Gender differences in the sleep variables contributing to excessive daytime sleepiness among patients with obstructive sleep apnea

Sleep And Breathing ◽

10.1007/s11325-020-02276-x ◽

2021 ◽

Author(s):

Eliya Honig ◽

Amit Green ◽

Yaron Dagan

Keyword(s):

Gender Differences ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Apnea Hypopnea Index ◽

Blood Oxygen ◽

Blood Oxygen Saturation ◽

Test Parameters ◽

Obstructive Sleep

Abstract Purpose Excessive daytime sleepiness (EDS) is a main symptom in patients with obstructive sleep apnea (OSA); however, patients with OSA have significant variability in their reported EDS which cannot be fully explained by the apnea-hypopnea index (AHI). The purpose of this study was to investigate gender differences regarding the sleep test variables contributing to excessive daytime sleepiness. Methods Retrospective study of 578 men and 270 women with suspected OSA who underwent home overnight sleep test. We assessed the correlation between sleep test variables and EDS, using the Epworth Sleepiness Scale (ESS). Results Among the group of men, correlation was found between ESS to BMI (r = .107, p = .010), AHI (r = .158, p < .001), number of apneas (r = .129, p = .002), number of hypopneas (r = .115, p = .006), number of blood oxygen desaturations (r = .145, p < .001), and percent of time the blood oxygen saturation was under 90% (r = .130, p = .002). However, among the group of women, no significant correlation was found between any of the sleep test parameters or BMI to ESS. Among the group of women, a negative correlation was found between age and EDS (r = − .208, p < .001). Conclusion Men showed correlations between sleep test variables and EDS, while women did not show such correlations. The results suggest that men’s sleepiness is more influenced by OSA and sleep variables compared to women. To our knowledge, this is the first study which shows difference between genders in the influence of sleep variables and OSA on EDS.

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