Download PDF
CC BY-NC-ND 4.0 · Sleep Sci 2018; 11(03): 160-165
DOI: 10.5935/1984-0063.20180030
ORIGINAL ARTICLE

Simulated intention-to-treat analysis based on clinical parameters of patients at high risk for sleep apnea derivated to respiratory polygraphy

Eduardo Enrique Borsini
1   Hospital Británico de Buenos Aires, Sleep Units - Buenos Aires City - Buenos Aires - Argentina.
,
Magali Blanco
1   Hospital Británico de Buenos Aires, Sleep Units - Buenos Aires City - Buenos Aires - Argentina.
,
Glenda Ernst
2   Hospital Británico de Buenos Aires, Center for Respiratory Medicine - Buenos Aires City - Buenos Aires - Argentina.
,
Paulina Montenegro
2   Hospital Británico de Buenos Aires, Center for Respiratory Medicine - Buenos Aires City - Buenos Aires - Argentina.
,
Alejandro Salvado
2   Hospital Británico de Buenos Aires, Center for Respiratory Medicine - Buenos Aires City - Buenos Aires - Argentina.
,
Carlos Nigro
3   Hospital Alemán, Sleep Units - Buenos Aires City - Buenos Aires - Argentina.
› Author Affiliations
› Further Information
   Permissions and Reprints

Purpose Obstructive Sleep Apnea-Hypopnea Syndrome (OSAS) is a public health problem. We designed a pilot study to validate empiric indication of CPAP therapy in a population with moderate-to-high pre-test probabilities who underwent self-administered home-based respiratory polygraphy (RP).

Methods A cross-sectional simulation study was performed. CPAP therapy could be indicated by two independent blind observers. Observer 1´s decision was based on the results of STOP-BANG (SBQ) and Epworth Sleepiness Scale (ESS) and Observer 2 used all objective data provided by RP + SBQ + ESS.

Results We evaluated 1763 patients; 1060 men and 703 women (39.2%) with a mean age of 53.6±13.8 and a body mass index (BMI) of 32.8±7.5 kg/m2. We found evidence of mild (34.1%), moderate (26.6%), and severe (18.3%) There were Apnea-Hypopnea Index (AHI) relationship between > 5 or < 5 SBQ and RP AHI (p<0.05). BMI > 25 kg/m2 + snoring (S) + observed apnea (O) + 1 of the following: ESS > 11, hypertension (HT) or > 5 SBQ components showed sensitivity of 40% (CI95%:37.3-43) and specificity of 95.1% (CI93.4-96.4). The performance of 5 SBQ components with regard to gender and empirical CPAP therapy was; (women vs. men): AUC-ROC 0.625 (CI95%: 0.599-0.651) vs. 0.70 (CI95%:0.68-0.72), p<0.01, respectively.

Conclusions STOP-BANG and ESS made it possible to indicate CPAP reliably (low rate of false-positive results) in 20-40% of patients who needed such therapy according to clinical history and RP results. These clinical criteria performed better in male.

Sleep Apnea Syndromes - Continuous Positive Airway Pressure - Decision Making

Funding:

No funding was received for this research.


Informed consent:

Informed consent was obtained from all individual participants included in the study.




Publication History

Received: 24 May 2018

Accepted: 09 August 2018

Article published online:
13 October 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • REFERENCES

  • 1 Phillipson EA. Sleep apnea--a mayor public health problem. N Engl J Med. 1993;328(17):1271-3.
  • 2 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle aged adults. N Engl J Med. 1993;328(17):1230-6.
  • 3 Durán J, Esnaola S, Ramón R, Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001;163(3 Pt 1):685-9.
  • 4 Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441-6.
  • 5 Consenso Nacional sobre el Síndrome Apneas-Hipopneas del Sueño del Grupo Español de Sueño (SAHS). Definición y concepto, fisiopatología, clínica y exploración del SAHS. Arch Bronconeumol. 2005;41(Suppl 4):12-29.
  • 6 Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al.; Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007;3(7):737-47.
  • 7 Terán-Santos J, Jiménez-Gómez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med. 1999;340(11):847-51.
  • 8 Leung RS, Bradley TD. Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med. 2001;164(12):2147-65.
  • 9 Deegan PC, McNicholas WT. Predictive value of clinical features for the obstructive sleep apnoea syndrome. Eur Respir J. 1998;9(1):117-24.
  • 10 Rowley JA, Aboussouan LS, Badr MS. The use of clinical prediction formulas in the evaluation of obstructive sleep apnea. Sleep. 2000;23(7):929-38.
  • 11 Zerah-Lancner F, Lofaso F, d’Ortho MP, Delclaux C, Goldenberg F, Coste A, et al. Predictive value of pulmonary function parameters for sleep apnea syndrome. Am J Respir Crit Care Med. 2000;162(6):2208-12.
  • 12 Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med. 1997;127(8 Pt 1):581-7.
  • 13 Hofftein V, Szalai JP. Predictive value of clinical features in diagnosing obstructive sleep apnea. Sleep. 1993;16(2):118-22.
  • 14 Flemmons WW. Clinical practice. Obstructive sleep apnea. N Engl J Med. 2002;347(7):498-504.
  • 15 Nigro CA, Dibur E, Aragone MR, Borsini E, Ernst G, Nogueria F. Can CPAP be indicated in adult patients with suspected obstructive sleep apnea only on the basis of clinical data? Sleep Breath. 2016;20(1):175-82.
  • 16 Lloberes P, Durán-Cantolla J, Martínez-García MÁ, Marín JM, Ferrer A, Corral J, et al. Diagnosis and treatment of sleep apnea-hypopnea syndrome. Spanish Society of Pulmonology and Thoracic Surgery. Arch Bronconeumol. 2011;47(3):143-56.
  • 17 Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, et al.; American Academy of Sleep Medicine. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep related breathing disorders. Sleep. 2006;29(3):375-80.
  • 18 Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812-21.
  • 19 Chica-Urzola HL, Escobar-Córdoba F, Eslava-Schmalbach J. [Validating the Epworth sleepiness scale]. Rev Salud Publica (Bogota). 2007;9(4):558-67. [Article in Spanish].
  • 20 Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al.; American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597-619.
  • 21 Borsini E, Ernst G, Salvado A, Bosio M, Chertcoff J, Nogueira F, et al. Utility of the STOP-BANG components to identify sleep apnea using home respiratory polygraphy. Sleep Breath. 2015;19(4):1327-33.
  • 22 Trenaman L, Munro S, Almeida F, Ayas N, Hicklin J, Bansback N. Development of a patient decision aid prototype for adults with obstructive sleep apnea. Sleep Breath. 2016;20(2):653-61.
  • 23 Anttalainen U, Liippo K, Saaresranta T. Diagnosis and initiation of nasal continuous positive airway pressure therapy for OSAS without a preceding sleep study? Sleep Breath. 2011;15(4):791-7.
  • 24 Wilson K, Stoohs RA, Mulrooney TF, Johnson LJ, Guilleminault C, Huang Z. The snoring spectrum: acoustic assessment of snoring sound intensity in 1,139 individuals undergoing polysomnography. Chest. 1999;115(3):762-70.
  • 25 Shepertycky MR, Banno K, Kryger MH. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep. 2005;28(3):309-14.