Ken M Kunisaki1,2, Oksana A Bohn3,4, Erin E Wetherbee3,4, Thomas S Rector3,4. 1. Pulmonary, Critical Care, and Sleep Apnea (111N), Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA. kunis001@umn.edu. 2. University of Minnesota, Minneapolis, MN, USA. kunis001@umn.edu. 3. Pulmonary, Critical Care, and Sleep Apnea (111N), Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA. 4. University of Minnesota, Minneapolis, MN, USA.
Abstract
BACKGROUND: Reducing the need for diagnostic sleep studies for obstructive sleep apnea (OSA) would reduce direct and opportunity costs while expediting time to treatment for this common and morbid disorder. We sought to determine if an established sleep apnea screening questionnaire (STOP-BANG) and wrist-worn overnight oximetry data could provide high positive predictive value for the presence of OSA. METHODS: We conducted a prospective observational study of consecutive unattended sleep study patients at a single facility. Patients were referred for sleep testing after chart review by a sleep physician. We assessed area under the receiver-operating characteristic curve (ROC AUC) and positive predictive value (PPV) of STOP-BANG score and oxygen desaturation index (ODI) for a respiratory disturbance index (RDI) ≥15/h. RESULTS: Among 234 test patients, 65 % had an RDI ≥15/h. STOP-BANG had poor ability to discriminate these patients (ROC AUC 0.62). ODI added significant diagnostic information to the STOP-BANG score, increasing the ROC AUC to 0.86. Having the ODI, the STOP-BANG score no longer contributed significant diagnostic information, and the ODI alone discriminated as well as the combination (ROC AUC 0.86). Forty nine percent had an ODI ≥7/h, which had PPV of 92 % (95 % confidence interval (CI), 86 to 96 %). In the validation sample of 1,196 consecutive patients, ODI ≥ 7/h had a PPV of 97 % (95 % CI, 95 to 97 %). CONCLUSIONS: Among patients with a high prevalence of OSA, high ODI is common and its presence has high PPV for OSA. These data suggest that overnight oximetry prior to sleep testing could significantly reduce the number of patients requiring sleep studies, thereby reducing costs and time to treatment.
BACKGROUND: Reducing the need for diagnostic sleep studies for obstructive sleep apnea (OSA) would reduce direct and opportunity costs while expediting time to treatment for this common and morbid disorder. We sought to determine if an established sleep apnea screening questionnaire (STOP-BANG) and wrist-worn overnight oximetry data could provide high positive predictive value for the presence of OSA. METHODS: We conducted a prospective observational study of consecutive unattended sleep study patients at a single facility. Patients were referred for sleep testing after chart review by a sleep physician. We assessed area under the receiver-operating characteristic curve (ROC AUC) and positive predictive value (PPV) of STOP-BANG score and oxygen desaturation index (ODI) for a respiratory disturbance index (RDI) ≥15/h. RESULTS: Among 234 test patients, 65 % had an RDI ≥15/h. STOP-BANG had poor ability to discriminate these patients (ROC AUC 0.62). ODI added significant diagnostic information to the STOP-BANG score, increasing the ROC AUC to 0.86. Having the ODI, the STOP-BANG score no longer contributed significant diagnostic information, and the ODI alone discriminated as well as the combination (ROC AUC 0.86). Forty nine percent had an ODI ≥7/h, which had PPV of 92 % (95 % confidence interval (CI), 86 to 96 %). In the validation sample of 1,196 consecutive patients, ODI ≥ 7/h had a PPV of 97 % (95 % CI, 95 to 97 %). CONCLUSIONS: Among patients with a high prevalence of OSA, high ODI is common and its presence has high PPV for OSA. These data suggest that overnight oximetry prior to sleep testing could significantly reduce the number of patients requiring sleep studies, thereby reducing costs and time to treatment.
Entities:
Keywords:
Oximetry; Predictive value of tests; Questionnaires; Sleep apnea syndromes
Authors: Samuel T Kuna; Indira Gurubhagavatula; Greg Maislin; Sakhena Hin; Kathryn C Hartwig; Sue McCloskey; Robert Hachadoorian; Sharon Hurley; Rajesh Gupta; Bethany Staley; Charles W Atwood Journal: Am J Respir Crit Care Med Date: 2011-01-21 Impact factor: 21.405
Authors: Ji Ho Choi; Eun Joong Kim; Yang Soo Kim; June Choi; Tae Hoon Kim; Soon Young Kwon; Heung Man Lee; Sang Hag Lee; Chol Shin; Seung Hoon Lee Journal: Acta Otolaryngol Date: 2010-07 Impact factor: 1.494
Authors: Stephen D Pittman; Najib T Ayas; Mary M MacDonald; Atul Malhotra; Robert B Fogel; David P White Journal: Sleep Date: 2004-08-01 Impact factor: 5.849
Authors: Yvonne Ng; Simon A Joosten; Bradley A Edwards; Anthony Turton; Helen Romios; Thilini Samarasinghe; Shane Landry; Darren R Mansfield; Garun S Hamilton Journal: J Clin Sleep Med Date: 2017-04-15 Impact factor: 4.062
Authors: Timon M Fabius; Jeffrey R Benistant; Lindsey Bekkedam; Job van der Palen; Frans H C de Jongh; Michiel M M Eijsvogel Journal: Sleep Breath Date: 2018-03-21 Impact factor: 2.816
Authors: Ken M Kunisaki; Davide De Francesco; Caroline A Sabin; Alan Winston; Patrick W G Mallon; Jane Anderson; Emmanouil Bagkeris; Marta Boffito; Nicki Doyle; Lewis Haddow; Frank A Post; Memory Sachikonye; Jaime Vera; Wajahat Khalil; Susan Redline Journal: Open Forum Infect Dis Date: 2020-11-18 Impact factor: 4.423
Authors: Timon M Fabius; Jeffrey R Benistant; Rick G Pleijhuis; Job van der Palen; Michiel M M Eijsvogel Journal: Sleep Breath Date: 2019-04-06 Impact factor: 2.816
Authors: Joshua M Bock; Kirk J Rodysill; Andrew D Calvin; Soumya Vungarala; Karine R Sahakyan; Stephen S Cha; Anna Svatikova; Francisco Lopez-Jimenez; Virend K Somers Journal: Front Cardiovasc Med Date: 2021-12-15