title: Screening for severe obstructive sleep apnea syndrome in hypertensive outpatients.
abstract: The authors attempted to validate a 2-stage strategy to screen for severe obstructive sleep apnea syndrome (s-OSAS) among hypertensive outpatients, with polysomnography (PSG) as the gold standard. Using a prospective design, outpatients with hypertension were recruited from medical outpatient clinics. Interventions included (1) assessment of clinical data; (2) home sleep testing (HST); and (3) 12-channnel, in-laboratory PSG. The authors developed models using clinical or HST data alone (single-stage models) or clinical data in tandem with HST (2-stage models) to predict s-OSAS. For each model, area under receiver operating characteristic curves (AUCs), sensitivity, specificity, negative likelihood ratio, and negative post-test probability (NPTP) were computed. Models were then rank-ordered based on AUC values and NPTP. HST used alone had limited accuracy (AUC=0.727, NPTP=2.9%). However, models that used clinical data in tandem with HST were more accurate in identifying s-OSAS, with lower NPTP: (1) facial morphometrics (AUC=0.816, NPTP=0.6%); (2) neck circumference (AUC=0.803, NPTP=1.7%); and Multivariable Apnea Prediction Score (AUC=0.799, NPTP=1.5%) where sensitivity, specificity, and NPTP were evaluated at optimal thresholds. Therefore, HST combined with clinical data can be useful in identifying s-OSAS in hypertensive outpatients, without incurring greater cost and patient burden associated with in-laboratory PSG. These models were less useful in identifying obstructive sleep apnea syndrome of any severity.
authors.affiliation: Pulmonary and Critical Care and Sleep Section, Philadelphia VA Medical Center, Philadelphia, PA 19104, USA.
authors.forename: Indira
authors.initials: I
authors.lastname: Gurubhagavatula
authors.forename: Barry G
authors.initials: BG
authors.lastname: Fields
authors.forename: Christian R
authors.initials: CR
authors.lastname: Morales
authors.forename: Sharon
authors.initials: S
authors.lastname: Hurley
authors.forename: Grace W
authors.initials: GW
authors.lastname: Pien
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Wick
authors.forename: Bethany A
authors.initials: BA
authors.lastname: Staley
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.forename: Greg
authors.initials: G
authors.lastname: Maislin
mesh_terms: D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008875:Middle Aged; D010045:Outpatients; D017286:Polysomnography / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D063189:Symptom Assessment / Q000379:methods*
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