title: The utility of the elbow sign in the diagnosis of OSA.
abstract: BACKGROUND
  Multiple questionnaires have been used to predict the diagnosis of OSA. Such models typically have multiple questions requiring cumulative scoring for interpretation. We wanted to determine whether a simple two-part questionnaire has predictive value in the pretest clinical evaluation for OSA.
  
  
  METHODS
  A questionnaire consisting of two questions--(1) Does your bed partner ever poke or elbow you because you are snoring? and (2) Does your bed partner ever poke or elbow you because you have stopped breathing?--was prospectively administered to patients evaluated in a sleep disorders clinic prior to undergoing polysomnography. Age, sex, BMI, and Epworth Sleepiness Scale data were collected.
  
  
  RESULTS
  Among the 128 patients who had a polysomnogram, answering "yes" to being awakened for snoring increased the OR of an apnea-hypopnea index≥5/h 3.9 times compared with "no." Answering "yes" to being awakened for apneic spells was associated with an OR of 5.8 for an apnea-hypopnea index≥5/h compared with "no." These associations did not differ by sex, BMI, Epworth Sleepiness Scale or answering "yes" to the other question. Subjects>50 years old with OSA were less likely to report a positive elbow sign and had a significantly lower OR for being awakened for apneic spells than those<50 years old. The sensitivity and specificity of being awakened for apneic spells was 65% and 76%, respectively, with a positive predictive value of 90%. Subgroup analysis revealed that in men with a BMI>31 a positive elbow sign had a specificity of 96.6% for a diagnosis of OSA.
  
  
  CONCLUSIONS
  Among patients referred to a sleep disorders clinic, a positive response to being elbowed/poked for apneic spells significantly improves the pretest prediction of OSA.
authors.affiliation: Division of Respirology, Critical Care and Sleep Medicine, and Clinical Research Support Unit, University of Saskatchewan, Saskatoon, SK, Canada. Electronic address: mark.fenton@usask.ca.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Fenton
authors.affiliation: Division of Respirology, Critical Care and Sleep Medicine, and Clinical Research Support Unit, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Heathcote
authors.affiliation: Division of Respirology, Critical Care and Sleep Medicine, and Clinical Research Support Unit, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Bryce
authors.affiliation: Division of Respirology, Critical Care and Sleep Medicine, and Clinical Research Support Unit, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Skomro
authors.affiliation: Division of Respirology, Critical Care and Sleep Medicine, and Clinical Research Support Unit, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: John K
authors.initials: JK
authors.lastname: Reid
authors.affiliation: Division of Respirology, Critical Care and Sleep Medicine, and Clinical Research Support Unit, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Gjevre
authors.affiliation: Division of Respirology, Critical Care and Sleep Medicine, and Clinical Research Support Unit, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Cotton
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004550:Elbow; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012913:Snoring / Q000175:diagnosis / Q000209:etiology; D011795:Surveys and Questionnaires