Indian Journal of Sleep Medicine

Register      Login

VOLUME 14 , ISSUE 4 ( October-December, 2019 ) > List of Articles

Original Article

Utility of Combination of Sleep Questionnaires in Predicting Obstructive Sleep Apnea and its Correlation with Polysomnography

Patro Mahismita, U. C. Ojha, Gothi Dipti, Jain Anshul, Palai Shrabani, Sah R Baboo, Vaidya Sameer

Keywords : Obstructive sleep apnea, Polysomnography, Sleep questionnaires

Citation Information : Mahismita P, Ojha UC, Dipti G, Anshul J, Shrabani P, Baboo SR, Sameer V. Utility of Combination of Sleep Questionnaires in Predicting Obstructive Sleep Apnea and its Correlation with Polysomnography. Indian Sleep Med 2019; 14 (4):61-66.

DOI: 10.5005/jp-journals-10069-0046

License: CC BY-NC 4.0

Published Online: 18-07-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Introduction: A number of screening questionnaires and clinical screening models have been developed to identify patients with obstructive sleep apnea syndrome (OSAS). These questionnaires lack reliability, and their predictability varies. Hence, it is difficult to predict or rule out OSAS on one questionnaire alone. The combination of two or more questionnaires might be helpful in ruling out OSAS. Objectives: (1) To determine the sensitivity, specificity, and predictive values of combination of two or more sleep questionnaires out of three established sleep questionnaires, i.e., Epworth sleepiness scale (ESS), perioperative sleep apnea prediction score (PSAP), STOP-Bang, in predicting OSAS and correlation with severity of OSAS. (2) To compare and correlate ESS, PSAP, and STOP-Bang individually with apnea–hypopnea index (AHI) obtained by polysomnography (PSG). Materials and methods: It was a prospective observational study conducted in a tertiary care center from January 2018 to August 2019 involving 250 cases of suspected OSAS. All the participants were interviewed for the three questionnaires followed by diagnostic type I PSG. Results: Comparing the individual questionnaires, ESS had higher sensitivity but low specificity, whereas PSAP had higher specificity. Perioperative sleep apnea prediction [area under curve (AUC) = 0.743 for any OSAS and 0.722 for moderate-to-severe OSAS] had a better prediction for OSAS. For predicting any OSAS, the combination of STOP-Bang + ESS + PSAP had a sensitivity of 95.76, specificity of 24.59%, and high negative predictive value (NPV) of 65.22%. For predicting moderate-to-severe OSAS, the combination of STOP-Bang + ESS + PSAP had a sensitivity of 92.59, specificity of 36.06%, and high NPV of 61.11%. Conclusion: The combination of questionnaires especially STOP-Bang, ESS, and PSAP improves the sensitivity of detection up to 95%, and when all of them are negative, OSAS is ruled out with around 65% confidence. So, using this combination can help us to identify high-risk patients and prioritize them for PSG so that they can get early treatment.

  1. Sharma SK, Katoch VM, Mohan A, et al. Consensus & evidence-based INOSAS guidelines 2014, 1st ed., Indian J Med Res 2014;140:451–468.
  2. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328(17):1230–1235. DOI: 10.1056/NEJM199304293281704.
  3. Udwadia ZF, Doshi AV, Lonkar SG, et al. Prevalence of sleep-disordered breathing and sleep apnea in middle-aged urban Indian men. Am J Respir Crit Care Med 2004;169(2):168–173. DOI: 10.1164/rccm.200302-265OC.
  4. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177(9): 1006–1014. DOI: 10.1093/aje/kws342.
  5. Sharma SK, Kumpawat S, Banga A, et al. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest 2006;130(1):149–156. DOI: 10.1378/chest.130.1.149.
  6. Vijayan VK, Patial K. Prevalence of obstructive sleep apnea syndrome in Delhi, India. Chest 2006;130(4):92S. DOI: 10.1378/chest.130.4_MeetingAbstracts.92S-c.
  7. Suri JC, Sen MK, Adhikari T. Epidemiology of sleep disorders in the adult population of Delhi: a questionnaire based study. Indian J Sleep Med 2008;3:128–137.
  8. Reddy EV, Kadhiravan T, Mishra HK, et al. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: a community-based study. Sleep Med 2009;10(8):913–918. DOI: 10.1016/j.sleep.2008.08.011.
  9. Pham LV, Schwartz AR. The pathogenesis of obstructive sleep apnea. J Thorac Dis 2015;7:1358–1372.
  10. Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20(9):705–706. DOI: 10.1093/sleep/20.9.705.
  11. Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anesth 2010;57(5):423–438. DOI: 10.1007/s12630-010-9280-x.
  12. Saxena M, Gothi D, Sah R, et al. Utility of combining epworth sleepiness scale, stop-bang and perioperative sleep apnea prediction score for predicting absence of obstructive sleep apnea. Indian Sleep Med 2018;13:62–66.
  13. Ulasli SS, Gunay E, Koyuncu T, et al. Predictive value of Berlin questionnaire and Epworth sleepiness scale for obstructive sleep apnea in a sleep clinic population. Clin Respir J 2014;8(3):292–296. DOI: 10.1111/crj.12070.
  14. Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;108(5):812–821. DOI: 10.1097/ALN.0b013e31816d83e4.
  15. Bajpai G, Shukla G, Pandey R, et al. Validation of a modified hindi version of the epworth sleepiness scale among a North Indian population. Ann Indian Acad Neurol 2016;19(4):499–504. DOI: 10.4103/0972-2327.194427.
  16. Johns MW. A new method for measuring daytime sleepiness: the epworth sleepiness scale. Sleep 1991;14(6):540–545. DOI: 10.1093/sleep/14.6.540.
  17. Ramachandran SK, Kheterpal S, Consens F. Derivation and validation of a simple perioperative sleep apnea prediction score. Anesth Analg 2010;110(4):1007–1015. DOI: 10.1213/ANE.0b013e3181d489b0.
  18. Charan J, Biswas T. How to calculate sample size for different study designs in medical research. Indian J Psychol Med 2013;35(2):121–126. DOI: 10.4103/0253-7176.116232.
  19. Luo J, Huang R, Zhong X, et al. Value of STOPBang questionnaire in screening patients with obstructive sleep apnea hypopnea syndrome in sleep disordered breathing clinic. Chin Med J (Engl) 2014;127(10):1843–1848.
  20. Quaranta VN, Dragonieri S, Carratu P, et al. A new approach for the assessment of sleepiness and predictivity of obstructive sleep apnea in the drivers: a pilot study. Lung India: official organ of Indian Chest Society 2016;33(1):14–19. DOI: 10.4103/0970-2113.173061.
  21. Utpat K, Bansal S, Desai U, et al. Clinical profile of obstructive sleep apnea syndrome in a tertiary care hospital in Western India. Indian Sleep Med 2019;14:1–6.
  22. Verbraecken J, Hedner J, Penzel T. Pre-operative screening for obstructive sleep apnoea. Eur Respir Rev 2017;26(143):160012. DOI: 10.1183/16000617.0012-2016.
  23. Ong TH, Raudha S, Fook-Chong S, et al. Simplifying STOPBANG: use of a simple questionnaire to screen for OSAS in an Asian population. Sleep Breath 2010;14(4):371–376. DOI: 10.1007/s11325-010-0350-7.
  24. Vana KD, Silva GE, Goldberg R. Predictive abilities of the STOPBang and epworth sleepiness scale in identifying sleep clinic patients at high risk for obstructive sleep apnea. Res Nurs Health 2013;36(1): 84–94. DOI: 10.1002/nur.21512.
  25. Martinez D, Breitenbach TC, Lumertz MS. Repeating administration of epworth sleepiness scale is clinically useful. Sleep Breath 2011;15(4):763–773. DOI: 10.1007/s11325-010-0434-4.
  26. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med 2017;13(3):479–504. DOI: 10.5664/jcsm.6506.
  27. Facco FL, Ouyang DW, Zee PC, et al. Development of a pregnancy specific screening tool for sleep apnea. J Clin Sleep Med 2012;8(4): 389–394. DOI: 10.5664/jcsm.2030.
  28. Cowan DC, Allardice G, MacFarlane D, et al. Predicting sleep disordered breathing in outpatients with suspected OSAS. BMJ Open 2014;4(4):e004519. DOI: 10.1136/bmjopen-2013-004519.
  29. Kim B, Lee EM, Chung Y-S, et al. The utility of three screening questionnaires for obstructive sleep apnea in a sleep clinic setting. Yonsei Med J 2015;56(3):684–690. DOI: 10.3349/ymj.2015.56.3.684.
  30. Faria AC, da Costa CH, Rufino R. Sleep apnea clinical score, Berlin questionnaire, or epworth sleepiness scale: which is the best obstructive sleep apnea predictor in patients with COPD? Int J Gen Med 2015;8:275–281. DOI: 10.2147/IJGM.S86479.
  31. Sayed IHE. Comparison of four sleep questionnaires for screening obstructive sleep apnea. Egypt J Chest Dis And Tuberc 2012;61(4): 433–441. DOI: 10.1016/j.ejcdt.2012.07.003.
  32. Silva GE, Vana KD, Goodwin JL, et al. Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOPBang, and Epworth sleepiness scales. J Clin Sleep Med 2011;7(5):467–472. DOI: 10.5664/JCSM.1308.
  33. Pataka A, Daskalopoulou E, Kalamaras G, et al. Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic. Sleep Med 2014;15(7):776–781. DOI: 10.1016/j.sleep.2014.03.012.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.