Risa Nakase-Richardson1, Daniel J Schwartz2, Leah Drasher-Phillips3, Jessica M Ketchum4, Karel Calero2, Marie N Dahdah5, Kimberley R Monden6, Kathleen Bell7, Ulysses Magalang8, Jeanne M Hoffman9, John Whyte10, Jennifer Bogner11, Jamie M Zeitzer12. 1. Mental Health and Behavioral Sciences, Defense and Veterans Brain Injury Center at James A. Haley Veterans' Hospital, Tampa, Florida; Division of Pulmonary and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida. Electronic address: Risa.Richardson@va.gov. 2. Division of Pulmonary and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida; Medicine Service, James A. Haley Veterans' Hospital, Tampa, Florida. 3. Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida. 4. Research Department, Craig Hospital, Englewood, Colorado. 5. Baylor Scott & White Institute for Rehabilitation, Dallas, Texas; Baylor Scott & White Medical Center, Plano, Texas. 6. Research Department, Craig Hospital, Englewood, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado. 7. Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas. 8. Division of Pulmonary, Critical Care, and Sleep Medicine and Neuroscience Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio. 9. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington. 10. Moss Rehabilitation Research Institute, Albert Einstein Healthcare Network, Elkins Park, Pennsylvania. 11. Division of Rehabilitation Psychology, Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio. 12. Department of Psychiatry and Behavioral Service, Stanford University, Stanford, California; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California.
Abstract
OBJECTIVE: To determine the diagnostic sensitivity and specificity and comparative effectiveness of traditional sleep apnea screening tools in traumatic brain injury (TBI) neurorehabilitation admissions. DESIGN: Prospective diagnostic comparative effectiveness trial of sleep apnea screening tools relative to the criterion standard, attended level 1 polysomnography including encephalography. SETTING: Six TBI Model System Inpatient Rehabilitation Centers. PARTICIPANTS: Between May 2017 and February 2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Area under the curve (AUC) of screening tools relative to total apnea hypopnea index≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (interquartile range, 29-47). RESULTS: The Berlin high-risk score (receiving operating curve [ROC] AUC=0.634) was inferior to the Multivariable Apnea Prediction Index (MAPI) (ROC AUC=0.780) (P=.0211; CI, 0.018-0.223) and Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender (STOPBANG) score (ROC AUC=0.785) (P=.001; CI, 0.063-0.230), both of which had comparable AUC (P=.7245; CI, -0.047 to 0.068). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI≥5. The pattern was similar across TBI severity subgroups except for posttraumatic amnesia (PTA) status wherein the MAPI outperformed the Berlin. Youden's index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples. CONCLUSION: This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.
OBJECTIVE: To determine the diagnostic sensitivity and specificity and comparative effectiveness of traditional sleep apnea screening tools in traumatic brain injury (TBI) neurorehabilitation admissions. DESIGN: Prospective diagnostic comparative effectiveness trial of sleep apnea screening tools relative to the criterion standard, attended level 1 polysomnography including encephalography. SETTING: Six TBI Model System Inpatient Rehabilitation Centers. PARTICIPANTS: Between May 2017 and February 2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Area under the curve (AUC) of screening tools relative to total apnea hypopnea index≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (interquartile range, 29-47). RESULTS: The Berlin high-risk score (receiving operating curve [ROC] AUC=0.634) was inferior to the Multivariable Apnea Prediction Index (MAPI) (ROC AUC=0.780) (P=.0211; CI, 0.018-0.223) and Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender (STOPBANG) score (ROC AUC=0.785) (P=.001; CI, 0.063-0.230), both of which had comparable AUC (P=.7245; CI, -0.047 to 0.068). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI≥5. The pattern was similar across TBI severity subgroups except for posttraumatic amnesia (PTA) status wherein the MAPI outperformed the Berlin. Youden's index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples. CONCLUSION: This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.
Authors: Risa Nakase-Richardson; Marie N Dahdah; Emily Almeida; Peter Ricketti; Marc A Silva; Karel Calero; Ulysses Magalang; Daniel J Schwartz Journal: J Clin Sleep Med Date: 2020-06-15 Impact factor: 4.062
Authors: Amanda Garcia; Tea Reljic; Terri K Pogoda; Kimbra Kenney; Amma Agyemang; Maya Troyanskaya; Heather G Belanger; Elisabeth A Wilde; William C Walker; Risa Nakase-Richardson Journal: J Neurotrauma Date: 2020-09-01 Impact factor: 5.269