Alyssa Cairns1, Greg Poulos1, Richard Bogan2. 1. SleepMed, Inc. Columbia, SC. 2. SleepMed, Inc. Columbia, SC and The University of South Carolina Medical School, Columbia, SC and The Medical University of South Carolina, Charleston, SC.
Abstract
STUDY OBJECTIVES: To address some of the questions about "who" has been tested for OSA (in terms of pretest risk and study outcomes) using a leading national portable recorder (PR; "home sleep test"). DESIGN: This was a retrospective analysis of a large repository of de-identified test results and pretest OSA risk from 2009 to 2013. SETTING AND PATIENTS: A total of 244,602 patients were referred for testing from a variety of clinical practices across North America. A total of 193,221 studies were included in the final analyses. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: The final sample was predominately male (59%), middle-aged (53.5 ± 14.2 years), obese (BMI >30; 54%), with a large neck circumference (males = 16.9 ± 1.2 in; females = 15.0 ± 1.3 in) and a mild degree of reported sleepiness (ESS 8.7±5.3). Approximately 50% of the sample endorsed a history of hypertension. The majority of patients (89.6%) were at a high risk for OSA as assessed by the ARES screening questionnaire. Of this group, 79.9% had an AHI ≥5 (MAHI = 18.2 ± 18.1) and 98% had an RDI ≥5 (MRDI = 28.0 ± 19.6). The majority of patients (~60%) that screened at no apparent risk for OSA indeed had AHIs <5 events/h. Those with a high pretest risk for OSA but low test outcomes (AHI <5) were twice as likely to be female and approximately 20% to 30% more likely to report a history of insomnia, lung disease, and/or stroke. CONCLUSIONS: The majority of PR has been conducted on patients with a high degree of suspicion for OSA. These data suggest that PR has been used in patients with a high pretest probability of OSA. Patients with a history of insomnia, stroke, and/ or lung disease may especially benefit by a comprehensive evaluation by a physician trained in sleep medicine, especially if PR results are negative for OSA. Future studies should evaluate the utility of gender-appropriate screening measures. Although questionnaire-based screening is helpful in determining OSA risk, it is imperative that it be used in conjunction with clinical decision-making.
STUDY OBJECTIVES: To address some of the questions about "who" has been tested for OSA (in terms of pretest risk and study outcomes) using a leading national portable recorder (PR; "home sleep test"). DESIGN: This was a retrospective analysis of a large repository of de-identified test results and pretest OSA risk from 2009 to 2013. SETTING AND PATIENTS: A total of 244,602 patients were referred for testing from a variety of clinical practices across North America. A total of 193,221 studies were included in the final analyses. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: The final sample was predominately male (59%), middle-aged (53.5 ± 14.2 years), obese (BMI >30; 54%), with a large neck circumference (males = 16.9 ± 1.2 in; females = 15.0 ± 1.3 in) and a mild degree of reported sleepiness (ESS 8.7±5.3). Approximately 50% of the sample endorsed a history of hypertension. The majority of patients (89.6%) were at a high risk for OSA as assessed by the ARES screening questionnaire. Of this group, 79.9% had an AHI ≥5 (MAHI = 18.2 ± 18.1) and 98% had an RDI ≥5 (MRDI = 28.0 ± 19.6). The majority of patients (~60%) that screened at no apparent risk for OSA indeed had AHIs <5 events/h. Those with a high pretest risk for OSA but low test outcomes (AHI <5) were twice as likely to be female and approximately 20% to 30% more likely to report a history of insomnia, lung disease, and/or stroke. CONCLUSIONS: The majority of PR has been conducted on patients with a high degree of suspicion for OSA. These data suggest that PR has been used in patients with a high pretest probability of OSA. Patients with a history of insomnia, stroke, and/ or lung disease may especially benefit by a comprehensive evaluation by a physician trained in sleep medicine, especially if PR results are negative for OSA. Future studies should evaluate the utility of gender-appropriate screening measures. Although questionnaire-based screening is helpful in determining OSA risk, it is imperative that it be used in conjunction with clinical decision-making.
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