Systematic Review and Meta-analysis of the Literature Regarding the Diagnosis of Sleep Apnea

Ross, SD; Allen, I. Elaine; Harrison, K. J.; Kvasz, Marion; Jb, Connelly; Sheinhait, IA

doi:10.1093/sleep/23.4.1f

Cited by 170 publications

(100 citation statements)

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“…39 Oximetry alone has been shown to have a mean sensitivity of 87% and mean specificity of 65% when compared with the gold standard full polysomnography. 40 This data suggests that pulse oximetry can be a useful investigation to positively diagnose OSAHS, although may have limitations in disease exclusion in patients with milder symptoms. 39 Our cohort of confirmed OSAHS patients among the referrals was, therefore, likely to be under-diagnosed, but include the more clinically relevant subgroup of patients with significant disease.…”

Section: Discussionmentioning

confidence: 94%

Ocular findings in sleep apnoea patients using continuous positive airway pressure

Kadyan

Asghar²,

Dowson

et al. 2009

Eye

107

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Purpose To describe ocular findings in patients with established obstructive sleep apnoea hypopnoea syndrome (OSAHS) using continuous positive airway pressure (CPAP). Methods One hundred and fifteen referrals investigated for OSAHS were included. Patients with OSAHS were compared with those with normal sleep study controls. Subgroup analysis for CPAP users and nonusers was also carried out. Results OSAHS patients (n ¼ 89) compared with the controls (n ¼ 26) had higher ocular irritation symptoms (Po0.001), abnormal tear break-up time (Po0.05) with increased upper (Po0.001) and lower (Po0.001) lid laxity. Floppy eyelid syndrome (FES) was noted in 31.5% (28/89) OSAHS patients vs 3.8% (1/26) controls (P ¼ 0.005). Open angle glaucoma prevalence in OSAHS patients (3/89, 3.4%) was similar to the controls (1/26, 3.8%) (P ¼ 0.92). Sixty-seven (75.3%) OSAHS patients were using CPAP (average duration: 19.6 ± 15.3 months). All CPAP users maintained a supine sleep posture to prevent mask edge leaks. A fifth of CPAP users (14/67) had experienced earlier episodes of conjunctivitis secondary to leaks. CPAP users had similar upper and lower lid laxity (P ¼ 0.746 and 0.633) to non-CPAP users, but a better tear film (P ¼ 0.029) and less ocular irritation (P ¼ 0.134). Conclusion OSAHS patients showed increased ocular irritation, abnormal tear film, lid laxity, and FES. The prevalence of glaucoma in our series was similar to normal population data of 2%, P ¼ 0.429, and may relate to use of CPAP in majority of the patients. More stable tear film in CPAP users was probably secondary to the supine sleep postures necessarily adopted with CPAP use.

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Section: Discussionmentioning

confidence: 94%

Ocular findings in sleep apnoea patients using continuous positive airway pressure

Kadyan

Asghar²,

Dowson

et al. 2009

Eye

107

View full text Add to dashboard Cite

show abstract

“…Conversely, an ideal diagnostic test in a population with a high pre-test probability of disease should have higher sensitivity while maintaining high specificity. 40 Lack of a standard definition for some factors involved in OSA questionnaires could also result in the heterogeneity of the data among the studies. For example, the cutoff numbers used for BMI ranged from 25-35, and different scales were used for snoring in the questionnaires.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of screening questionnaires for obstructive sleep apnea

Abrishami

Khajehdehi

Chung

2010

Can J Anesth/J Can Anesth

483

341

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Purpose Obstructive sleep apnea (OSA) may lead to lifethreatening problems if it is left undiagnosed. Polysomnography is the ''gold standard'' for OSA diagnosis; however, it is expensive and not widely available. The objective of this systematic review is to identify and evaluate the available questionnaires for screening OSA. Source We carried out a literature search through MEDLINE, EMBASE, and CINAHL to identify eligible studies. The methodological validity of each study was assessed using the Cochrane Methods Group's guideline. Principal findings Ten studies (n = 1,484 patients) met the inclusion criteria. The Berlin questionnaire was the most common questionnaire (four studies) followed by the Wisconsin sleep questionnaire (two studies). Four studies were conducted exclusively on ''sleep-disorder patients'', and six studies were conducted on ''patients without history of sleep disorders''. For the first group, pooled sensitivity was 72.0% (95% confidence interval [CI]: 66.0-78.0%; I 2 = 23.0%) and pooled specificity was 61.0% (95% CI: 55.0-67.0%; I 2 = 43.8%). For the second group, pooled sensitivity was 77.0% (95% CI: 73.0-80.0%; I 2 = 78.1%) and pooled specificity was 53.0% (95% CI: 50-57%; I 2 = 88.8%). The risk of verification bias could not be eliminated in eight studies due to insufficient reporting. Studies on snoring, tiredness, observed apnea, and high blood pressure (STOP) and STOP including body mass index, age, neck circumference, gender (Bang) questionnaires had the highest methodological quality. ConclusionThe existing evidence regarding the accuracy of OSA questionnaires is associated with promising but inconsistent results. This inconsistency could be due to studies with heterogeneous design (population, questionnaire type, validity). STOP and STOP-Bang questionnaires for screening of OSA in the surgical population are suggested due to their higher methodological quality and easyto-use features. RésuméObjectif L'apne´e obstructive du sommeil (AOS) peut provoquer des proble`mes de sante´fatals si elle n'est pas diagnostique´e. La polysomnographie est «l'e´talon or» du diagnostic de l'AOS; cependant, cette me´thode est one´reuse et n'est pas disponible partout. L

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“…In all cases, the devices were tested on a single night, and in the majority of cases, the devices were not studied in the home setting (Flemons et al, 2003;Ross et al, 2000). This may make diagnoses made on the basis of such devices vulnerable to night-tonight variability in OSA measurement (Mosko, Dickel, & Ashurst, 1988).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic test evaluation of a nasal flow monitor for obstructive sleep apnea detection in sleep apnea research

et al. 2008

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In this diagnostic test evaluation of a nasal flow monitoring device for obstructive sleep apnea (OSA), 34 patients referred for polysomnography were studied at home for three consecutive nights with the monitor. The mean age of subjects (±SD) was 41.9±10.3 years, and their mean apnea-hypopnea index (AHI) was 31.5±27.2. The difference between the average AHI from three nights at home on the monitor and the polysomnogram (PSG) result was 1.8±17.1. The area under the receiver operating characteristic curve (AUC) for PSG All ? 10 was .96. With a threshold AHI of 18 on the flow monitor, sensitivity was .92, specificity .86, positive predictive value .96, and negative predictive value .75. For detecting severe OSA (AIR ? 30), the AUC was .85. With knowledge of appropriate thresholds and the pretest risk of OSA, the flow monitor can be used to detect or exclude OSA for sleep-related research, as well as to identify severe cases needing priority for further evaluation.

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Systematic Review and Meta-analysis of the Literature Regarding the Diagnosis of Sleep Apnea

Cited by 170 publications

References 0 publications

Ocular findings in sleep apnoea patients using continuous positive airway pressure

Ocular findings in sleep apnoea patients using continuous positive airway pressure

A systematic review of screening questionnaires for obstructive sleep apnea

Diagnostic test evaluation of a nasal flow monitor for obstructive sleep apnea detection in sleep apnea research

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