Ricardo L M Duarte1,2, Flavio J Magalhães-da-Silveira3, Tiago S Oliveira-E-Sá4,5, Marcelo F Rabahi6, Fernanda C Q Mello7, David Gozal8. 1. Centro Médico BarraShopping, Sleep - Laboratório de Estudo Dos Distúrbios Do Sono, Avenida das Américas 4666, sala 309, Barra da Tijuca, Rio de Janeiro, 22649-900, Brazil. rlmduarte@gmail.com. 2. Instituto de Doenças Do Tórax - Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil. rlmduarte@gmail.com. 3. Centro Médico BarraShopping, Sleep - Laboratório de Estudo Dos Distúrbios Do Sono, Avenida das Américas 4666, sala 309, Barra da Tijuca, Rio de Janeiro, 22649-900, Brazil. 4. Centro Hospitalar Lisboa Central, Hospital de Santa Marta, Lisbon, Portugal. 5. NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal. 6. Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, Brazil. 7. Instituto de Doenças Do Tórax - Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil. 8. Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA.
Abstract
PURPOSE: Obstructive sleep apnea (OSA) and insomnia are very prevalent disorders, especially in sleep-lab setting, and insomnia may be the presenting complaint of OSA. Here, we aimed to validate No-Apnea as screening tool for OSA in patients with self-reported insomnia complaints and to compare its performance with other models. METHODS: This cross-sectional study involved evaluation of No-Apnea as well as STOP-Bang, NoSAS and Epworth Sleepiness Scale (ESS) in subjects with insomnia being evaluated with full in-lab polysomnography. Discrimination was assessed by area under the curve (AUC), while predictive parameters were calculated by contingency tables. OSA severity was classified based on the apnea/hypopnea index: ≥ 5.0/h as any OSA (OSA≥5), ≥ 15.0/h as moderate/severe OSA (OSA≥15), and ≥ 30.0/h as severe OSA (OSA≥30). RESULTS: Overall, 2591 patients with a clinical diagnosis of insomnia were included. Diagnosis of OSA≥5, OSA≥15, and OSA≥30 was of 76.3%, 53.1%, and 32.6%, respectively. At all levels of OSA severity, No-Apnea had sensitivity ranging from 84.5 to 94.1% and specificity ranging from 58.2 to 35.1%. For screening of OSA≥5, OSA≥15, and OSA≥30, discriminatory ability (AUC) of No-Apnea was: 0.790 [95% confidence interval (CI) 0.770-0.810], 0.758 (95% CI 0.740-0.777), and 0.753 (95% CI 0.734-0.772), respectively. Based on AUCs, No-Apnea, STOP-Bang, and NoSAS performed similar at all levels of OSA severity. The ESS did not present satisfactory discrimination as OSA screening model. CONCLUSIONS: In a large sample of patients with insomnia, No-Apnea, STOP-Bang, and NoSAS, but not ESS, enable satisfactory and similar discrimination at all levels of OSA severity.
PURPOSE: Obstructive sleep apnea (OSA) and insomnia are very prevalent disorders, especially in sleep-lab setting, and insomnia may be the presenting complaint of OSA. Here, we aimed to validate No-Apnea as screening tool for OSA in patients with self-reported insomnia complaints and to compare its performance with other models. METHODS: This cross-sectional study involved evaluation of No-Apnea as well as STOP-Bang, NoSAS and Epworth Sleepiness Scale (ESS) in subjects with insomnia being evaluated with full in-lab polysomnography. Discrimination was assessed by area under the curve (AUC), while predictive parameters were calculated by contingency tables. OSA severity was classified based on the apnea/hypopnea index: ≥ 5.0/h as any OSA (OSA≥5), ≥ 15.0/h as moderate/severe OSA (OSA≥15), and ≥ 30.0/h as severe OSA (OSA≥30). RESULTS: Overall, 2591 patients with a clinical diagnosis of insomnia were included. Diagnosis of OSA≥5, OSA≥15, and OSA≥30 was of 76.3%, 53.1%, and 32.6%, respectively. At all levels of OSA severity, No-Apnea had sensitivity ranging from 84.5 to 94.1% and specificity ranging from 58.2 to 35.1%. For screening of OSA≥5, OSA≥15, and OSA≥30, discriminatory ability (AUC) of No-Apnea was: 0.790 [95% confidence interval (CI) 0.770-0.810], 0.758 (95% CI 0.740-0.777), and 0.753 (95% CI 0.734-0.772), respectively. Based on AUCs, No-Apnea, STOP-Bang, and NoSAS performed similar at all levels of OSA severity. The ESS did not present satisfactory discrimination as OSA screening model. CONCLUSIONS: In a large sample of patients with insomnia, No-Apnea, STOP-Bang, and NoSAS, but not ESS, enable satisfactory and similar discrimination at all levels of OSA severity.
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