A two-tier screening model using quality-of-life measures and pulse oximetry to screen adults with sleep-disordered breathing.
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.
Chen
Ning-Hung
NH
Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Taiwan, China.
Chen
Min-Chi
MC
Li
Hsueh-Yu
HY
Chen
Chang-Wei
CW
Wang
Pa-Chun
PC
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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