TY - JOUR
T1 - Detecting sleep apnoea syndrome in primary care with screening questionnaires and the Epworth sleepiness scale
AU - Senaratna, Chamara V.
AU - Perret, Jennifer L.
AU - Lowe, Adrian
AU - Bowatte, Gayan
AU - Abramson, Michael J.
AU - Thompson, Bruce
AU - Lodge, Caroline
AU - Russell, Melissa
AU - Hamilton, Garun S.
AU - Dharmage, Shyamali C.
PY - 2019/7
Y1 - 2019/7
N2 - Objective: To examine the utility of apnoea screening questionnaires, alone and in combination with the Epworth sleepiness scale (ESS), for detecting obstructive sleep apnoea (OSA) in primary care. Design, setting: Prospective validation study in an Australian general population cohort. Participants: 424 of 772 randomly invited Tasmanian Longitudinal Health Study, 6th decade follow-up participants with OSA symptoms (mean age, 52.9 years; SD, 0.9 year) who completed OSA screening questionnaires and underwent type 4 sleep studies. Main outcome measures: Clinically relevant OSA, defined as moderate to severe OSA (15 or more oxygen desaturation events/hour), or mild OSA (5–14 events/hour) and excessive daytime sleepiness (ESS ≥ 8); diagnostic test properties of the Berlin (BQ), STOP-Bang and OSA-50 questionnaires, alone or combined with an ESS ≥ 8. Results: STOP-Bang and OSA-50 correctly identified most participants with clinically relevant OSA (sensitivity, 81% and 86% respectively), but with poor specificity (36% and 21% respectively); the specificity (59%) and sensitivity of the BQ (65%) were both low. When combined with the criterion ESS ≥ 8, the specificity of each questionnaire was high (94–96%), but sensitivity was low (36–51%). Sensitivity and specificity could be adjusted according to specific needs by varying the STOP-Bang cut-off score when combined with the ESS ≥ 8 criterion. Conclusions: For people likely to trigger OSA assessment in primary care, the STOP-Bang, BQ, and OSA-50 questionnaires, combined with the ESS, can be used to rule in, but not to rule out clinically relevant OSA. Combined use of the STOP-Bang with different cut-off scores and the ESS facilitates a flexible balance between sensitivity and specificity.
AB - Objective: To examine the utility of apnoea screening questionnaires, alone and in combination with the Epworth sleepiness scale (ESS), for detecting obstructive sleep apnoea (OSA) in primary care. Design, setting: Prospective validation study in an Australian general population cohort. Participants: 424 of 772 randomly invited Tasmanian Longitudinal Health Study, 6th decade follow-up participants with OSA symptoms (mean age, 52.9 years; SD, 0.9 year) who completed OSA screening questionnaires and underwent type 4 sleep studies. Main outcome measures: Clinically relevant OSA, defined as moderate to severe OSA (15 or more oxygen desaturation events/hour), or mild OSA (5–14 events/hour) and excessive daytime sleepiness (ESS ≥ 8); diagnostic test properties of the Berlin (BQ), STOP-Bang and OSA-50 questionnaires, alone or combined with an ESS ≥ 8. Results: STOP-Bang and OSA-50 correctly identified most participants with clinically relevant OSA (sensitivity, 81% and 86% respectively), but with poor specificity (36% and 21% respectively); the specificity (59%) and sensitivity of the BQ (65%) were both low. When combined with the criterion ESS ≥ 8, the specificity of each questionnaire was high (94–96%), but sensitivity was low (36–51%). Sensitivity and specificity could be adjusted according to specific needs by varying the STOP-Bang cut-off score when combined with the ESS ≥ 8 criterion. Conclusions: For people likely to trigger OSA assessment in primary care, the STOP-Bang, BQ, and OSA-50 questionnaires, combined with the ESS, can be used to rule in, but not to rule out clinically relevant OSA. Combined use of the STOP-Bang with different cut-off scores and the ESS facilitates a flexible balance between sensitivity and specificity.
KW - Primary care
KW - Sleep apnea
UR - http://www.scopus.com/inward/record.url?scp=85065306840&partnerID=8YFLogxK
U2 - 10.5694/mja2.50145
DO - 10.5694/mja2.50145
M3 - Article
C2 - 31049990
AN - SCOPUS:85065306840
VL - 211
SP - 65
EP - 70
JO - The Medical Journal of Australia
JF - The Medical Journal of Australia
SN - 0025-729X
IS - 2
ER -