Indian Journal of Sleep Medicine

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VOLUME 17 , ISSUE 3 ( July-September, 2022 ) > List of Articles

Original Article

Comparison of Various Pretest Probability Scores in Obstructive Sleep Apnea Syndrome

Sucheta Sunil Bhalerao, Dhiraj Bhatkar

Keywords : Apnea–hypopnea index, Continuous positive airway pressure, Daytime sleepiness, Epworth sleepiness scale, Metabolic syndrome, Obesity, Obesity hypoventilation syndrome, Overlap Syndrome, Sleep-disordered breathing, Syndrome Z

Citation Information : Bhalerao SS, Bhatkar D. Comparison of Various Pretest Probability Scores in Obstructive Sleep Apnea Syndrome. Indian Sleep Med 2022; 17 (3):77-82.

DOI: 10.5005/jp-journals-10069-0105

License: CC BY-NC 4.0

Published Online: 19-10-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: In Obstructive sleep apnea (OSA), there is upper airway collapsibility, and obstruction to the flow of air thereby leading to arousal. In view of the rising prevalence of OSA, there is a need for precise tools which are less complicated to identify patients with sleep disorder for early diagnosis and to prevent serious complications. Therefore, it is of utmost importance to classify patients depending on their clinical symptoms and examination and risk factors to identify patients at higher risk and the need for polysomnography (PSG) and further management. Materials and methods: This was a prospective study conducted with institutional ethics committee (IEC) permission, which included 100 patients referred to the Department of Pulmonary Medicine of our tertiary care center, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, Maharashtra, India. Specificity, sensitivity, and negative and positive predictive values of each pretest probability score [sleep apnea clinical score (SACS), snoring, tiredness, observed apnea, blood pressure, body mass index (BMI), age, neck size, gender (STOP-BANG) questionnaire, Berlin questionnaire (BQ), and four-variable tool (4-VT) questionnaire] were calculated. These scores were plotted against apnea–hypopnea Index (AHI) and the correlation coefficient of these pretest probability scores were compared with each other. Results: Among the 100 patients screened, 93 patients had OSA. Epworth sleepiness scale (ESS) classified that 87% of patients were at risk of OSA. Also, 70, 93, 93, and 49% were at higher risk by SACS, STOP-BANG, BQ, and 4-VT questionnaires, respectively. Conclusion: There is a need for screening patients with sleep-disordered breathing (SDB) to find out such patients and to refer such patients to higher centers where diagnostics facilities are available. Our study showed that various pretest probability questionnaires can be used to screen patients in resource-limited settings, such as primary and non-primary healthcare settings, where there was a limited number of sleep laboratories available.


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  1. Parati G, Lombardi C, Narkiewicz K. Sleep apnea: Epidemiology, pathophysiology, and relation to cardiovascular risk. Am J Physiol Regul Integr Comp Physiol 2007;293(4):R1671–R183. DOI: 10.1152/ajpregu.00400.2007.
  2. Bickelmann AG, Burwell CS, Robin ED, et al. Extreme obesity associated with alveolar hypoventilation: A Pickwickian syndrome. Am J Med 1956;21(5):811–818. DOI: 10.1016/0002-9343(56)90094-8.
  3. 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.
  4. Bearpark H, Elliott L, Grunstein R, et al. Snoring and sleep apnea: A population study in Australian men. Am J Respir Crit Care Med 1995;151(5):1459–1465. DOI: 10.1164/ajrccm.151.5.7735600.
  5. Stardling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle-aged men. Thorax 1997;46(2): 85–90. DOI: 10.1136/thx.46.2.85.
  6. Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: Effects of gender. Am J Respir Crit Care Med 2001;163(3 Pt. 1):608–613. DOI: 10.1164/ajrccm.163.3.9911064.
  7. Ancoli–Israel S, Kripke DF, Klauber MR, et al. Sleepdisordered breathing in community-dwelling elderly. Sleep 1991;14(6):486–495. DOI: 10.1093/sleep/14.6.486.
  8. Sharma SK, Reddy EV, Sharma A, et al. Prevalence and risk factors of syndrome Z in urban Indians. Sleep Med 2010;11(6):562–568. DOI: 10.1016/j.sleep.2010.02.008.
  9. Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Canad J Anesth 2010;57(5):423–438. DOI: 10.1007/s12630-010-9280-x.
  10. Murray W. Johns. Reliability and factor analysis of the Epworth sleepiness scale. Sleep 1992;15(4):376–381. DOI: 10.1093/sleep/15.4.376.
  11. Silva GE, Vana KD, Goodwin JL, et al. Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth Sleepiness Scales. J Clin Sleep Med 2011;7(5):467–472. DOI: 10.5664/JCSM.1308.
  12. Takegami M, Hayashino Y, Chin K, et al. Simple four-variable screening tool for identification of patients with sleep-disordered breathing. Sleep 2009;32(7):939–948. PMID: 19639757.
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