title: In-home, self-assembled sleep studies are useful in diagnosing sleep apnea in the elderly.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) is common and treatable among the elderly. Yet, few older adults seek evaluation for OSA at sleep disorders centers. The authors assessed the feasibility of a two-stage screening procedure for obstructive sleep apnea syndrome (OSAS) in a community-based sample of older adults.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Participants' domicile (in-home) and academic sleep research center.
  
  
  METHODS
  There were 452 Medicare recipients residing in the greater Philadelphia metropolitan area with the complaint of daytime sleepiness.
  
  
  METHODS
  None.
  
  
  RESULTS
  All participants underwent in-home unattended sleep studies that recorded airflow, and standard in-laboratory polysomnography. Additional measures included symptoms of sleep apnea, body mass index, neck circumference, age, and sex. When comparing diagnostic approaches, the best-performing single-stage model was one that combined apnea symptoms with age and neck circumference. This model had an area under the receiver operating characteristic curve (AUC) of 0.774 and negative posttest probability of 1.2%. The best-performing two-stage model combined symptoms, neck circumference, age, and sex in the first stage, followed by an unattended portable study with a corresponding AUC of 0.85 and negative posttest probability of 0.5%.
  
  
  CONCLUSIONS
  Unattended, self-assembled, in-home sleep studies recording airflow and respiratory effort are most useful if applied in tandem with clinical data, including a carefully obtained sleep history. This two-stage model is accurate in identifying severe OSAS in older adults and represents a practical diagnostic approach for older adults. Incorporating clinical data was vital and increased accuracy well above that of unattended studies of airflow and effort alone.
authors.affiliation: Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Christian R
authors.initials: CR
authors.lastname: Morales
authors.forename: Sharon
authors.initials: S
authors.lastname: Hurley
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Wick
authors.forename: Bethany
authors.initials: B
authors.lastname: Staley
authors.forename: Frances M
authors.initials: FM
authors.lastname: Pack
authors.forename: Nalaka S
authors.initials: NS
authors.lastname: Gooneratne
authors.forename: Greg
authors.initials: G
authors.lastname: Maislin
authors.forename: Allan
authors.initials: A
authors.lastname: Pack
authors.forename: Indira
authors.initials: I
authors.lastname: Gurubhagavatula
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015992:Body Mass Index; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015143:Philadelphia; D017286:Polysomnography / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*
keywords: Aged adults; obstructive sleep apnea; portable sleep studies; screening