A simplified model of screening questionnaire and home monitoring for obstructive sleep apnoea in primary care

Chai-Coetzer, Ching Li; Antic, Nick A.; Rowland, Lesley; Catcheside, Peter; Esterman, Adrian; Reed, Richard; Williams, Helena; Dunn, Sandra; McEvoy, R. Doug

doi:10.1136/thx.2010.152801

Cited by 201 publications

(175 citation statements)

References 37 publications

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“…The formulation of these recommendation statements was guided by evidence from twenty-six validation studies that evaluated the diagnostic accuracy of HSAT against PSG, 35,53,62,67,81, as well as seven RCTs that compared clinical outcomes from management pathways. [83][84][85][107][108][109][110] Four of these RCTs were determined to be most relevant to clinical practice, as they did not require oximetry testing as a criterion for inclusion and used conventional methods for determination of PAP pressures (i.e., APAP or attended titration).…”

Section: Discussionmentioning

confidence: 99%

“…The OSA50 questionnaire involves four components including age ≥ 50, snoring, witnessed apneas and waist circumference. 81 A study involving Turkish bus drivers 82 and a validation study for the OSA50 in the primary care setting 81 showed a sensitivity ranging from 0.49-0.98 and a specificity of 0.82 in both studies (see supplemental material, Table S32 and Table S33). …”

Section: Multivariable Apnea Prediction Questionnairementioning

confidence: 99%

“…When the performance of 2-3 channel HSAT was evaluated against unattended in-home PSG, using a cutoff of AHI ≥ 15, accuracy in a high-risk population was 86% (95% CI: 76% to 93%); 53 using a cutoff of AHI ≥ 30, accuracy ranged from 83% to 91% (see supplemental material, Table S45 and Table S46). 53,81 Six studies evaluated the performance of single channel HSAT against attended or unattended PSG (see supplemental material, Table S47 through Table S50, and Table S51 through Table S53, respectively). 73,[100][101][102][103]111 A single study evaluated the performance of oximetry against unattended in-home PSG.…”

Section: Accuracymentioning

confidence: 99%

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Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Kapur

Auckley

Chowdhuri

et al. 2017

Journal of Clinical Sleep Medicine

1,899

1,498

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Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. Recommendations:The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements:Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation. Recommendations:1. We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG) 2. We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG) 3. We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG) 4. We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG) 5. We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protoc...

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Section: Discussionmentioning

confidence: 99%

Section: Multivariable Apnea Prediction Questionnairementioning

confidence: 99%

Section: Accuracymentioning

confidence: 99%

See 1 more Smart Citation

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Kapur

Auckley

Chowdhuri

et al. 2017

Journal of Clinical Sleep Medicine

1,899

1,498

View full text Add to dashboard Cite

show abstract

“…The mean nocturnal SaO 2 (<SaO2>) and SaO 2 nadir were registered. Since ApneaLink does not differentiate between central or obstructive respiratory events, mild SDB was diagnosed in the presence of an ODI between 2 and 5 and severe SDB was defined by an ODI of ≥5 (15,16,18).…”

Section: Sleep Assessmentmentioning

confidence: 99%

“…Sleep assessment was performed using a portable device (ApneaLink, ResMed, Basel, Switzerland; refs [15][16][17], at baseline and after 4-6 months of therapy when SDB was observed during the first investigation. Respiratory airflow was measured by a nasal pressure cannula (detecting −10 hPa to +10 hPa) and oxygen saturation (SaO 2 ) and pulse rate were obtained by using a pulse oxymeter and a pulse sensor (sampling rate of 1 Hz).…”

Section: Sleep Assessmentmentioning

confidence: 99%

Weight Loss and Sleep‐Disordered Breathing in Childhood Obesity: Effects on Inflammation and Uric Acid

Hoorenbeeck

Franckx²,

Debode³

et al. 2012

Obesity

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Sleep‐disordered breathing (SDB) is prevalent in childhood obesity. It may be an independent risk factor for the metabolic syndrome. Possible mechanisms are inflammation and oxidative stress. Adenotonsillectomy in childhood obesity is associated with a high recurrence rate and risk of postoperative weight gain. Therefore, this study assessed the effects of SDB on inflammation and oxidative stress in childhood obesity before and after weight loss. We included 132 obese subjects between 10 and 18 years consecutively. Median age was 15.4 years (10.1–18.0). Mean BMI z‐score was 2.72 ± 0.42. Leukocytes and differentiation, high sensitivity C‐reactive protein (hs‐CRP), and uric acid (UA) were determined at baseline and subjects underwent a sleep assessment. SDB was diagnosed in 39%. Linear regression analysis showed an association between UAlog and oxygen desaturation indexlog (ODIlog) (r = 0.20; P = 0.03), between leukocyteslog and respiratory disturbance indexlog (RDIlog) (r = 0.23; P = 0.01), and between lymphocyteslog and RDIlog (r = 0.19; P = 0.04). Follow‐up was organized after 4–6 months of treatment. Median decrease in BMI z‐score was 32%. Laboratory measurements were repeated. Subjects with SDB at baseline underwent a second sleep study. Of these 49 subjects, 12 showed residual SDB. This corresponds with a treatment success rate of 71%. Unlike changes in inflammatory markers, improvements in UA were associated with improvements in RDI and ODI (respectively: r = 0.44; P = 0.007, r = 0.41; P = 0.01). In conclusion, weight loss is effective in treating obese children with SDB. At baseline, a link exists between inflammation and SDB. Oxidative stress is reflected by UA at baseline and the concentration decreases after treatment according to improvements in SDB.

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Primary Care vs Specialist Sleep Center Management of Obstructive Sleep Apnea and Daytime Sleepiness and Quality of Life

Chai-Coetzer

Antic²,

Rowland³

et al. 2013

JAMA

172

128

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A simplified model of screening questionnaire and home monitoring for obstructive sleep apnoea in primary care

Cited by 201 publications

References 37 publications

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Weight Loss and Sleep‐Disordered Breathing in Childhood Obesity: Effects on Inflammation and Uric Acid

Primary Care vs Specialist Sleep Center Management of Obstructive Sleep Apnea and Daytime Sleepiness and Quality of Life

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