Comparison of six assessment tools to screen for obstructive sleep apnea in patients with hypertension

Abstract

Background: Obstructive sleep apnea (OSA) is often accompanied by other complications, especially hypertension. Hypothesis: The purpose of this study is to compare the application value of six tools in the screening of OSA in patients with hypertension. Compared with other questionnaires, we hypothesized that Berlin performed better in screening hypertensive patients suspected of OSA. Methods: In this study, we collected the basic data and polysomnography (PSG) data of patients diagnosed with hypertension who underwent PSG at the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from April 2012 to March 2021. The sensitivity, specificity, positive predictive value, negative predictive value, area under the curv (AUC) and diagnostic odds ratio (DOR) of the six screening tools were then calculated, and their correlation with the sleep apnea hypopnea index (AHI) analyzed.Results: There were 303 males (303/398, 76.1%) out of 398 hypertension patients suspected of OSA. The area under the curve of the Berlin questionnaire's receiver operating characteristic (ROC) curve reached 0.753 (95%CI: 0.707-0.794). When the AHI was 5, 15 and 30 times/h as the cut-off points, the sensitivity and negative predictive value of Berlin were the highest at 0.947 and 0.630, 0.970 and 0.851, and 0.988 and 0.957 respectively, while the specificity and positive predictive value of the Epworth Sleepiness Scale (ESS) were the highest at 0.

A portrait of obstructive sleep apnea risk factors in 27,210 middle-aged and older adults in the Canadian Longitudinal Study on Aging

“…Fifth, we estimated prevalence based on the presence of self-reported OSA symptoms and lacked any objective recordings, such as in-laboratory polysomnography or home sleep apnea testing. However, we based our STOP-Obesity cutoff score on recent meta-analyses and studies comparing polysomnography data to STOP-Bang scores ≥ 3 30 , 31 , 36 , 37 . In fact, using this score to detect moderate-to-severe OSA with a cutoff of 3 showed a sensitivity between 88% 30 and 94% 31 with a negative predictive value of 93% 30 .…”

“…Our adapted STOP-Obesity score could reach a maximum value of 5 instead of 4, and we considered participants scoring ≥ 3 to be at high-risk for having OSA. We established this cutoff based on recent meta-analyses and studies reporting a high sensitivity for a STOP-Bang score ≥ 3 in patients with mild, moderate and severe OSA 30 , 31 , 36 , 37 . As the CLSA does not include specific questions pertaining to a prior diagnosis of OSA, the terminology “being at high-risk for OSA” refers to the odds of presenting with OSA at the time of testing.…”

Ambulatory surgical patients and sleep apnea

“…13 While polysomnography is the gold standard, it is cumbersome, costly, and time consuming because of which several tools have been developed and validated for the diagnosis of OSA. 2,3,14 These include the Berlin Questionnaire, Epworth Sleepiness Scale, Perioperative Sleep Apnea Prediction Score, and the American Society of Anesthesiologists checklist. The earliest of these is the Berlin Questionnaire which consists of 10 questions divided into 3 categories that seek to identify severity of snoring, quantify daytime sleepiness, and the presence of obesity and hypertension.…”

“…Individuals with scores greater than or equal to 15 are considered as having a high risk of OSA. 14 The Epworth Sleepiness Scale is a self-administered questionnaire that measures daytime sleepiness in adults while performing different tasks. The likelihood of having sleep-disordered breathing is ranked out of a score of 24.…”

A Prediction Nomogram Combining Epworth Sleepiness Scale and Other Clinical Parameters to Predict Obstructive Sleep Apnea in Patients with Hypertension

“…Clinical questionnaires and scales (i.e., Epworth Sleepiness Scale [ESS], the STOP-Bang questionnaire [SBQ], and the Berlin questionnaire [BQ]) are used to diagnose OSA in the absence of standard PSG; however, these questionnaires have limitations [ 15 ]. Many OSA-related parameters, including body mass index (BMI), neck circumference (NC), gender, and comorbidities, are relevant for predicting OSA [ 16 , 17 ].…”