Screening tools for identifying a high probability of obstructive sleep apnea

Background. Obstructive sleep apnea (OSA) is a common medical problem that affects up to 5% of the population. The majority of OSA patients are undiagnosed and have a potential for perioperative complications. Our study was conducted to validate the most widely used screening tools for identifying high risk OSA patients and to find the most predictable physical signs and symptoms of OSA. Materials and methods. At the Sleep Laboratory of Riga Stradins University, 100 patients with suspected OSA were asked to fill in patient questionnaires prior to the sleep study. The patients’ anthropometric data, physical signs and medical history were collected. To confirm the diagnosis of OSA, all patients underwent a full night sleep study. To find the possible correlation, the data collected from the questionnaires were compared with the data from sleep studies. Results. Patients (n = 100) at a mean age of 47 yrs. (23–73), 22 women, 78 men. No OSA was found in 17%, mild OSA in 23%, moderate OSA in 21%, severe OSA in 39% of the patients. A strong correlation between the body mass index (BMI; p

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419 STOP-Bang Score and History of Radiation Predicts Risk of Obstructive Sleep Apnea in Cancer Patients: A Machine Learning Study

SLEEP ◽

10.1093/sleep/zsab072.418 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A166-A166

Author(s):

Ankita Paul ◽

Karen Wong ◽

Anup Das ◽

Diane Lim ◽

Miranda Tan

Keyword(s):

Machine Learning ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cancer Patients ◽

Prediction Accuracy ◽

Screening Tools ◽

Cancer Type ◽

Sleep Study ◽

Obstructive Sleep ◽

History Of

Abstract Introduction Cancer patients are at an increased risk of moderate-to-severe obstructive sleep apnea (OSA). The STOP-Bang score is a commonly used screening questionnaire to assess risk of OSA in the general population. We hypothesize that cancer-relevant features, like radiation therapy (RT), may be used to determine the risk of OSA in cancer patients. Machine learning (ML) with non-parametric regression is applied to increase the prediction accuracy of OSA risk. Methods Ten features namely STOP-Bang score, history of RT to the head/neck/thorax, cancer type, cancer stage, metastasis, hypertension, diabetes, asthma, COPD, and chronic kidney disease were extracted from a database of cancer patients with a sleep study. The ML technique, K-Nearest-Neighbor (KNN), with a range of k values (5 to 20), was chosen because, unlike Logistic Regression (LR), KNN is not presumptive of data distribution and mapping function, and supports non-linear relationships among features. A correlation heatmap was computed to identify features having high correlation with OSA. Principal Component Analysis (PCA) was performed on the correlated features and then KNN was applied on the components to predict the risk of OSA. Receiver Operating Characteristic (ROC) - Area Under Curve (AUC) and Precision-Recall curves were computed to compare and validate performance for different test sets and majority class scenarios. Results In our cohort of 174 cancer patients, the accuracy in determining OSA among cancer patients using STOP-Bang score was 82.3% (LR) and 90.69% (KNN) but reduced to 89.9% in KNN using all 10 features mentioned above. PCA + KNN application using STOP-Bang score and RT as features, increased prediction accuracy to 94.1%. We validated our ML approach using a separate cohort of 20 cancer patients; the accuracies in OSA prediction were 85.57% (LR), 91.1% (KNN), and 92.8% (PCA + KNN). Conclusion STOP-Bang score and history of RT can be useful to predict risk of OSA in cancer patients with the PCA + KNN approach. This ML technique can refine screening tools to improve prediction accuracy of OSA in cancer patients. Larger studies investigating additional features using ML may improve OSA screening accuracy in various populations Support (if any):

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Correlation of Lateral Cephalogram and Flexible Laryngoscopy with Sleep Study in Obstructive Sleep Apnea

International Journal of Otolaryngology ◽

10.1155/2015/127842 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7

Author(s):

Anila Narayanan ◽

Bini Faizal

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Screening Tools ◽

Definitive Treatment ◽

Outpatient Basis ◽

Lateral Cephalogram ◽

Sleep Study ◽

Flexible Laryngoscopy ◽

Obstructive Sleep ◽

Lateral Cephalometry

Objective. To study the correlation between lateral cephalogram, flexible laryngoscopy, and sleep study in patients diagnosed with obstructive sleep apnea (OSA).Background. Screening tools should be devised for predicting OSA which could be performed on an outpatient basis. With this aim we studied the skeletal and soft tissue characteristics of proven OSA patients.Methods. A prospective study was performed in patients diagnosed with obstructive sleep apnea by sleep study. They were evaluated clinically and subjected to lateral cephalometry and nasopharyngolaryngoscopy. The findings were matched to see if they corresponded to AHI of sleep study in severity. An attempt was made to see whether the data predicted the patients who would benefit from oral appliance or surgery as the definitive treatment in indicated cases.Results. A retropalatal collapse seen on endoscopy could be equated to the distance from mandibular plane to hyoid (MP-H) of lateral cephalometry and both corresponded to severity of AHI. At the retroglossal region, there was a significant correlation with MP-H, length of the soft palate, and AHI.Conclusion. There is significant correlation of lateral cephalogram and awake flexible nasopharyngolaryngoscopy with AHI in OSA. In unison they form an excellent screening tool for snorers.

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Identifying Signs and Symptoms of Obstructive Sleep Apnea in a Men’s Health Clinic: The Utility of Home Sleep Apnea Testing During COVID-19

American Journal of Men s Health ◽

10.1177/15579883211029460 ◽

2021 ◽

Vol 15 (3) ◽

pp. 155798832110294

Author(s):

Alexander Hart ◽

Steffanie Robertus ◽

Mark Dyken ◽

Amy Pearlman

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Retrospective Chart Review ◽

Signs And Symptoms ◽

Health Clinic ◽

Apnea Test ◽

Sleep Study ◽

Presenting Symptoms ◽

Obstructive Sleep ◽

Home Sleep Apnea Testing

The objective of the study was to identify symptoms of men presenting for an outpatient urology visit that prompted referral for a Home Sleep Apnea Test (HSAT) to assess for obstructive sleep apnea (OSA) by a single provider. To assess the proportion of patients referred for the HSAT who underwent the test and, out of these patients, the proportion of men diagnosed with sleep apnea, we performed a retrospective chart review of men 18–99 years old seen by a single provider in the Department of Urology referred for an HSAT to evaluate for presenting symptoms. Patients with a prior diagnosis of OSA were excluded. Eighteen patients were identified (mean age at time of referral 51 + SD 13 years). Half of patients reported erectile dysfunction/concerns, 56% reported nocturia, 44% had been diagnosed with testosterone deficiency, and 39% reported low libido. Nearly all (89%) of patients snored, all reported fatigue, 56% were over the age of 50, 44% had a BMI >35, and 78% had hypertension. Twelve patients completed the HSAT, all of whom were diagnosed with OSA for which continuous positive airway pressure (CPAP) therapy was initiated. Men presenting with genitourinary concerns to an outpatient urology clinic may also have OSA. About half of included patients reported genitourinary concerns. Hundred percent of patients who completed their sleep study were diagnosed with OSA. Genitourinary concerns, in addition to signs and symptoms commonly associated with OSA, should prompt consideration of sleep apnea evaluation.

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0611 Screening for Obstructive Sleep Apnea in the Bariatric Surgery Population

SLEEP ◽

10.1093/sleep/zsaa056.608 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A234-A234

Author(s):

K Kreitinger ◽

M M Lui ◽

R Owens ◽

C Schmickl ◽

E Grunvald ◽

...

Keyword(s):

Bariatric Surgery ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Statistical Significance ◽

Preoperative Evaluation ◽

Standard Of Care ◽

Screening Tools ◽

Apnea Hypopnea Index ◽

Sleep Study ◽

Obstructive Sleep

Abstract Introduction Obstructive sleep apnea (OSA) is prevalent in the bariatric surgery population and has been associated with increased perioperative risk, especially if OSA is moderate-severe (apnea-hypopnea index ≥ 15/h). Consequently, screening for OSA is recommended as part of the preoperative evaluation. Several screening tools for OSA have been developed; however, some tools lack validation and their relative performance is unclear. The purpose of this study was to compare four existing screening tools (Epworth Sleepiness Scale (ESS), STOP-BANG, NO-OSAS, and No-Apnea) with regards to the ability to identify patients with moderate-severe OSA among bariatric surgery patients. Methods We retrospectively reviewed data from Jan 2015 to Mar 2019 for adult patients presenting consecutively to UC San Diego for first-time bariatric surgery who had undergone a home or in-lab sleep study (within one year of the initial encounter for bariatric surgery), which is our standard of care. We compared the accuracy of the four screening tools for detecting moderate-severe OSA based on the area under the receiver operating characteristic curves (AUC). Subgroup analyses were explored based on sex, BMI, and ethnicity (Hispanic/Latino vs non-Hispanic/Latino). Results Of the 214 patients (83.2% female, median age 39 years) included in the study, 45.4% had moderate-severe OSA. STOP-BANG (AUC 0.75 [95%CI: 0.68 to 0.81]) and NO-OSAS (AUC 0.76 [95%CI: 0.69 to 0.82]) had similar performance (p 0.62); both performed significantly better than the ESS (AUC 0.61 [95%CI: 0.54 to 0.68]; p 0.02 for both). STOP-BANG and NO-OSAS tended to perform better in the female vs male subgroup, but this finding did not reach statistical significance. Conclusion STOP-BANG and NO-OSAS are superior to the ESS when screening bariatric surgery patients for moderate-severe OSA. In future analyses we will further explore if adjustments of standard cut-offs improve test characteristics (i.e. sensitivity/specificity) when screening bariatric surgery patients (analyses ongoing). Support None.

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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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Subjective and Objective Appraisal of Activity in Adults with Obstructive Sleep Apnea

Journal of Aging Research ◽

10.4061/2011/751819 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 19

Author(s):

Eileen R. Chasens ◽

Susan M. Sereika ◽

Martin P. Houze ◽

Patrick J. Strollo

Keyword(s):

Physical Activity ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Epworth Sleepiness Scale ◽

Functional Outcomes ◽

Apnea Hypopnea Index ◽

Sleep Study ◽

Obstructive Sleep ◽

Subjective Sleepiness ◽

Aging Adults

Objective.This study examined the association between obstructive sleep apnea (OSA), daytime sleepiness, functional activity, and objective physical activity.Setting.Subjects (N=37) being evaluated for OSA were recruited from a sleep clinic.Participants. The sample was balanced by gender (53% male), middle-aged, primarily White, and overweight or obese with a mean BMI of 33.98 (SD=7.35;median BMI=32.30). Over 40% reported subjective sleepiness (Epworth Sleepiness Scale (ESS) ≥10) and had OSA (78% with apnea + hypopnea index (AHI) ≥5/hr).Measurements.Evaluation included questionnaires to evaluate subjective sleepiness (Epworth Sleepiness Scale (ESS)) and functional outcomes (Functional Outcomes of Sleep Questionnaire (FOSQ)), an activity monitor, and an overnight sleep study to determine OSA severity.Results.Increased subjective sleepiness was significantly associated with lower scores on the FOSQ but not with average number of steps walked per day. A multiple regression analysis showed that higher AHI values were significantly associated with lower average number of steps walked per day after controlling patient's age, sex, and ESS.Conclusion.Subjective sleepiness was associated with perceived difficulty in activity but not with objectively measured activity. However, OSA severity was associated with decreased objective physical activity in aging adults.

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Cardiac arrhythmias and conduction disturbances in the obstructive sleep apnea syndrome

In a good rythm ◽

10.5604/01.3001.0012.0392 ◽

2018 ◽

Vol 2 (47) ◽

pp. 10-15

Author(s):

Danuta Łoboda ◽

Karolina Simionescu ◽

Anna Szajerska-Kurasiewicz ◽

Dorota Lasyk ◽

Grzegorz Jarosiński ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cardiac Arrhythmias ◽

Sleep Apnea Syndrome ◽

The Body ◽

Apnea Hypopnea Index ◽

Premature Ventricular Contractions ◽

Mortality And Morbidity ◽

Conduction Disturbances ◽

Obstructive Sleep

Cardiac arrhythmias during sleep are reported in almost half of the population suffering from obstructive sleep apnea (OSA). The most common are bradyarrhythmias and atrial fibrillation whereas premature ventricular contractions and nonsustained ventricular tachycardia are less frequent. The risk of arrhythmia is proportional to the body mass index (BMI), number of respiratory events per hour of sleep described with apnea/hypopnea index (AHI) and the level of oxygen desaturation during these episodes. Continuous positive airway pressure (CPAP) treatment in OSA reduces the incidence of cardiac arrhythmias therefore reduce mortality and morbidity from cardiovascular disease.

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Abstract P195: Lack of Association between Sleep Duration and ECG Arrhythmia Risk Measures: Chicago Area Sleep Study

Circulation ◽

10.1161/circ.127.suppl_12.ap195 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Jason Ng ◽

Phyllis C Zee ◽

Jeffrey J Goldberger ◽

Kristen L Knutson ◽

Kiang Liu ◽

...

Keyword(s):

Risk Factors ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Duration ◽

Low Risk ◽

Qtc Interval ◽

Sleep Study ◽

Chicago Area ◽

Obstructive Sleep ◽

Pr Interval

Introduction Sleep duration is significantly associated with cardiovascular disease risk factors such as hypertension, diabetes, and obesity in adults at low risk for obstructive sleep apnea. Although it is known that apnea increases the risk for sudden cardiac death, it is not known whether adults with short sleep duration independent of apnea have a higher risk for cardiac arrhythmias Hypothesis We tested the hypothesis that sleep duration in adults at low risk for obstructive sleep apnea would be associated with ECG measures that are known risk factors for ventricular arrhythmias. Methods The Chicago Area Sleep Study recruited 610 participants via commercially available telephone listings. Participants were screened using in-home apnea detection equipment (ApneaLinkTM) for one night to exclude subjects with apnea/hypopnea index ≥ 15. Participants wore wrist actigraphs for 7 days to objectively determine sleep duration. A 10-minute 12-lead ECG was recorded for each subject. Standard measures of heart rate, PR interval, and QTc interval were obtained along with markers of ventricular repolarization, Tpeak to Tend interval (Tpe) and spatial QRS-T angle. Signal-averaged ECG analysis was performed to measure filtered QRS duration (fQRSd), RMS voltage of terminal 40 ms (RMS), and duration of terminal QRS signals <40μV (LAS). Participants with atrial fibrillation, >20% ectopic beats and those using antihypertensive and sleep medications were excluded from analysis. The effect of sleep duration on the ECG parameters was estimated using a multiple linear regression model adjusting for demographics (sex, age, and race) and cardiovascular risk factors (BMI, hypertension, coronary heart disease, and diabetes). Results ECGs from a total of 504 participants (200 male, 48±8 years old) were analyzed. Mean sleep duration was 7±1 hrs, heart rate was 64±9 bpm, PR interval was 165±18 ms, and QTc interval was 424±23 ms. Mean Tpe interval was 83±14 ms and spatial QRS-T angle was 29±26 deg. The signal-averaged ECG measures of fQRSd, RMS, and LAS had mean values of 78±12 ms, 58±34 μV, and 24±9 ms, respectively. In an unadjusted model, there was a borderline association between sleep duration and QTc (β=0.004 ms/hr, SE=0.0023, p=0.08). However, that association was no longer significant following adjustment with demographics and cardiovascular risk factors. No other ECG measures were associated with sleep duration. Conclusions In a population at low risk of obstructive sleep apnea, ECG-based measures of cardiovascular risks were not associated with sleep duration. Previously reported associations between short sleep and cardiovascular events may not be arrhythmic in origin.

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Abstract 14771: Obstructive Sleep Apnea is Associated With Cardiac Dysfunction in Children With Congenital Heart Disease

Circulation ◽

10.1161/circ.142.suppl_3.14771 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Daniel Combs ◽

Vanessa Fernandez ◽

brent j barber ◽

Wayne J Morgan ◽

Chiu-Hsieh Hsu ◽

...

Keyword(s):

Congenital Heart Disease ◽

Obstructive Sleep Apnea ◽

Heart Disease ◽

Sleep Apnea ◽

Right Ventricular ◽

Cardiac Dysfunction ◽

Congenital Heart ◽

Left Ventricular ◽

Sleep Study ◽

Obstructive Sleep

Introduction: Obstructive sleep apnea (OSA) is associated with cardiac dysfunction in children without congenital heart disease (CHD). Children with CHD are at increased risk for OSA and may be susceptible to further cardiovascular consequences due to OSA but the extent and nature of such cardiovascular effects of OSA are unknown. Methods: Children (6-17 years old) with corrected CHD without current cyanosis or Down syndrome were recruited from pediatric cardiology clinic. Home sleep tests were done to determine the presence and severity of OSA. OSA was defined as an obstructive apnea hypopnea index (oAHI) ≥1. Mild OSA was defined as an oAHI of ≥1 to <5 and moderate OSA was defined as an oAHI of ≥5 to <10. Standard clinically indicated echocardiograms were performed in clinic. Echocardiographic findings were compared between children with CHD with and without comorbid OSA using t-tests, Wilcoxon-sign rank tests as well as linear or logistic regression as appropriate. Results: Thirty-two children had sleep study and echocardiographic data available. OSA was present in 18 children (56%). OSA was mild in 89% and moderate in 11% of cases. There were no significant differences in age, body mass index, CHD severity, gender or ethnicity between children with and without OSA. Children with OSA had larger height-indexed right ventricular end-diastolic diameter (RVDi) compared to those without OSA (median 1.35, 95% CI 1.09, 1.56 vs. 1.21, 95% CI 1.01, 1.57; p=0.04). Children with moderate OSA had a reduced left ventricular shortening fraction compared to both those with mild OSA and no OSA (30.0 ± 6.1% vs. 38.7 ± 4.4%; p=0.009 and 39.2 ± 3.6%; p=0.007, respectively). Children with moderate OSA had increased left ventricular end-systolic diameter compared to those with mild OSA and no OSA (3.4 ± 0.4 cm vs. 2.5 ± 0.4; p=0.007 and 2.4 ± 0.5; p=0.001, respectively). Children with an RVDi above the median were seven times more likely to have OSA than those with an RVDi below the median (odds ratio 6.9.; 95% CI 1.3, 35; p=0.02). Conclusions: OSA is associated with changes in cardiac morphology and reduced contractility in children with CHD. Additionally, the presence of right ventricular dilation may suggest the need for OSA evaluation in children with CHD.

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