title: A two-tier screening model using quality-of-life measures and pulse oximetry to screen adults with sleep-disordered breathing.
abstract: OBJECTIVE
  Using quality-of-life measures and pulse oximetry, this study developed a two-tiered prediction algorithm with an aim to prioritize sleep-disordered breathing patients for polysomnography.
  
  
  METHODS
  Data from 355 patients were evaluated to obtain their clinical information, Chinese version of Epworth sleepiness scale, and snore outcomes survey scores against respiratory disturbance index (RDI). In the first-tier screening, receiver-operating characteristics were calculated with an initial strategy of choosing optimal prediction sensitivity. The second-tier strategy investigated the association between pulse oximetry data (desaturation index of 3%) against RDI to optimize prediction specificity.
  
  
  RESULTS
  The "SOS score of 55 and ESS score of 9" was the optimal combination that yielded the highest sensitivity (0.603) in the first-tier screening. The strategy can includ 94.93% possible patients (probability = 0.6) with positive predictive value of 0.997. The area under the curve (AUC) was 0.88 (p < 0.001). Desaturation index of 3% would optimized specificity (0.966, probability = 0.5) in the second-tier screening to exclude 54% of innocent patients, with negative predictive values of 0.93 and AUC of 0.951 (p < 0.001). The two-tier screening model jointly excluded 4.8% of innocent subjects and prioritized 40% of severe patients for polysomnography.
  
  
  CONCLUSIONS
  The prediction model is sufficiently accurate and feasible for large-scale population screening.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taiwan, China.
authors.forename: Ning-Hung
authors.initials: NH
authors.lastname: Chen
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Chen
authors.forename: Hsueh-Yu
authors.initials: HY
authors.lastname: Li
authors.forename: Chang-Wei
authors.initials: CW
authors.lastname: Chen
authors.forename: Pa-Chun
authors.initials: PC
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003431:Cross-Cultural Comparison; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010092:Oximetry / Q000706:statistics & numerical data; D017286:Polysomnography / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires; D013624:Taiwan; D055815:Young Adult
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