title: SOS score: an optimized score to screen acute stroke patients for obstructive sleep apnea.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is frequent in acute stroke patients, and has been associated with higher mortality and worse prognosis. Polysomnography (PSG) is the gold standard diagnostic method for OSA, but it is impracticable as a routine for all acute stroke patients. We evaluated the accuracy of two OSA screening tools, the Berlin Questionnaire (BQ), and the Epworth Sleepiness Scale (ESS) when administered to relatives of acute stroke patients; we also compared these tools against a combined screening score (SOS score).
  
  
  METHODS
  Ischemic stroke patients were submitted to a full PSG at the first night after onset of symptoms. OSA severity was measured by apnea-hypopnea index (AHI). BQ and ESS were administered to relatives of stroke patients before the PSG and compared to SOS score for accuracy and C-statistics.
  
  
  RESULTS
  We prospectively studied 39 patients. OSA (AHI ≥10/h) was present in 76.9%. The SOS score [area under the curve (AUC): 0.812; P = 0.005] and ESS (AUC: 0.789; P = 0.009) had good predictive value for OSA. The SOS score was the only tool with significant predictive value (AUC: 0.686; P = 0.048) for severe OSA (AHI ≥30/h), when compared to ESS (P = 0.119) and BQ (P = 0.191). The threshold of SOS ≤10 showed high sensitivity (90%) and negative predictive value (96.2%) for OSA; SOS ≥20 showed high specificity (100%) and positive predictive value (92.5%) for severe OSA.
  
  
  CONCLUSIONS
  The SOS score administered to relatives of stroke patients is a useful tool to screen for OSA and may decrease the need for PSG in acute stroke setting.
authors.affiliation: Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil. Electronic address: millene.camilo@gmail.com.
authors.forename: Millene R
authors.initials: MR
authors.lastname: Camilo
authors.affiliation: Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Heidi H
authors.initials: HH
authors.lastname: Sander
authors.affiliation: Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Eckeli
authors.affiliation: Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Regina M F
authors.initials: RM
authors.lastname: Fernandes
authors.affiliation: Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Taiza E G
authors.initials: TE
authors.lastname: Dos Santos-Pontelli
authors.affiliation: Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Joao P
authors.initials: JP
authors.lastname: Leite
authors.affiliation: Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Octavio M
authors.initials: OM
authors.lastname: Pontes-Neto
mesh_terms: D000208:Acute Disease; D000368:Aged; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D017286:Polysomnography / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*
keywords: Acute cerebral infarction; Berlin Questionnaire; Epworth Sleepiness Scale; Sleep; Sleep apnea; Stroke