title: Sleep-disordered breathing in chronic heart failure: development and validation of a clinical screening score.
abstract: OBJECTIVE
  Sleep-disordered breathing (SDB) is highly prevalent and of adverse prognostic significance in patients with chronic heart failure (CHF). Polygraphy is used for diagnosing SDB but polygraphy resources fall short of needs. Here, our aim was to develop a score for SDB screening in patients with CHF.
  
  
  RESULTS
  Consecutive patients with stable chronic CHF referred to our CHF clinic for a scheduled follow-up evaluation were included prospectively between 2000 and 2012. SDB was defined as an apnoea-hypopnoea index ≥ 5/h as assessed by routine polygraphy. A screening score was developed as a linear combination of factors independently associated with SDB by multivariate logistic regression. Calibration and discrimination were evaluated using the Hosmer-Lemeshow (HL) test and area under the receiver-operating characteristics curve (AUC), respectively. Bootstrapping was performed to assess internal validity. Of 450 included patients (mean age, 59.5 ± 13.7 years), 397 (88%) had SDB. An easy-to-use score was based on age (2 points if ≥65 years), body mass index (2 points if ≥25 kg/m(2)), New York Heart Association (NYHA) class (2 points if ≥3 or 4) and male gender (3 points). A score cut-off of 5 was 78.9% sensitive and 61.5% specific for SDB. The final model exhibited adequate calibration (pHL ≥ 0.3) and discrimination (AUC, 0.737; 95% confidence interval, 0.663; 0.810).
  
  
  CONCLUSIONS
  An easy-to-use clinical score combining age, body mass index, NYHA class, and gender may help to identify those CHF patients most likely to have SDB, thereby improving the allocation of scarce polygraphy resources and early diagnosis of SDB.
authors: Public Health Department, APHP, Henri-Mondor Teaching Hospital, Créteil, F-94000, France; UPEC, Laboratoire d'Investigation Clinique (LIC), EA 4393, Créteil F-94000, France; INSERM Clinical Investigation Centre 006, Paris F-75000, France; Department of Clinical research and Public Health, Clinical Investigation Centre 006, Paris F-75000, France.
authors: Juliette
authors: J
authors: Parisot
authors: APHP, Department of Cardiology, Henri-Mondor Teaching Hospital, Créteil F-94000, France; INSERM, Unité U955 (team 8), Créteil F-94000, France; UPEC, DHU ATVB, Créteil F-94000, France; GRC Réseau Amylose Mondor at Henri mondor Teaching Hospital, Créteil F-94000, France. Electronic address: thibaud.damy@hmn.aphp.fr.
authors: Thibaud
authors: T
authors: Damy
authors: INSERM, Unité U955 (team 8), Créteil F-94000, France; UPEC, DHU ATVB, Créteil F-94000, France; GRC Réseau Amylose Mondor at Henri mondor Teaching Hospital, Créteil F-94000, France; APHP, Service de Physiologie- Explorations Fonctionnelles, Henri-Mondor Teaching Hospital, Créteil F-94000, France.
authors: Barnabas
authors: B
authors: Gellen
authors: APHP, Service de Physiologie- Explorations Fonctionnelles, Henri-Mondor Teaching Hospital, Créteil F-94000, France.
authors: Ala
authors: A
authors: Covali-Noroc
authors: APHP, Department of Cardiology, Henri-Mondor Teaching Hospital, Créteil F-94000, France; INSERM, Unité U955 (team 8), Créteil F-94000, France; UPEC, DHU ATVB, Créteil F-94000, France; GRC Réseau Amylose Mondor at Henri mondor Teaching Hospital, Créteil F-94000, France.
authors: Diane
authors: D
authors: Bodez
authors: APHP, Department of Cardiology, Henri-Mondor Teaching Hospital, Créteil F-94000, France; UPEC, DHU ATVB, Créteil F-94000, France; GRC Réseau Amylose Mondor at Henri mondor Teaching Hospital, Créteil F-94000, France.
authors: Stéphane
authors: S
authors: Rappeneau
authors: APHP, Department of Cardiology, Henri-Mondor Teaching Hospital, Créteil F-94000, France; UPEC, DHU ATVB, Créteil F-94000, France.
authors: Aziz
authors: A
authors: Guellich
authors: INSERM, Unité U955 (team 8), Créteil F-94000, France; UPEC, DHU ATVB, Créteil F-94000, France; APHP, Service de Physiologie- Explorations Fonctionnelles, Henri-Mondor Teaching Hospital, Créteil F-94000, France.
authors: Serge
authors: S
authors: Adnot
authors: Public Health Department, APHP, Henri-Mondor Teaching Hospital, Créteil, F-94000, France; UPEC, Laboratoire d'Investigation Clinique (LIC), EA 4393, Créteil F-94000, France; INSERM Clinical Investigation Centre 006, Paris F-75000, France; Department of Clinical research and Public Health, Clinical Investigation Centre 006, Paris F-75000, France; APHP, Clinical Research Unit (URC-Mondor), Henri-Mondor Teaching Hospital, Créteil F-94000, France.
authors: Sylvie
authors: S
authors: Bastuji-Garin
authors: APHP, Department of Cardiology, Henri-Mondor Teaching Hospital, Créteil F-94000, France; INSERM, Unité U955 (team 8), Créteil F-94000, France; UPEC, DHU ATVB, Créteil F-94000, France; GRC Réseau Amylose Mondor at Henri mondor Teaching Hospital, Créteil F-94000, France.
authors: Luc
authors: L
authors: Hittinger
authors: APHP, DHU Fire, Centre du Sommeil, Physiologie - Explorations Fonctionnelles, Bichat Teaching Hospital, Paris F-75000, France; Université Paris-Diderot Paris 7, Paris F-75000, France.
authors: Maria-Pia
authors: MP
authors: d'Ortho
authors: INSERM, Unité U955 (team 8), Créteil F-94000, France; UPEC, DHU ATVB, Créteil F-94000, France; APHP, Service de Physiologie- Explorations Fonctionnelles, Henri-Mondor Teaching Hospital, Créteil F-94000, France.
authors: Laurent
authors: L
authors: Boyer
authors: Public Health Department, APHP, Henri-Mondor Teaching Hospital, Créteil, F-94000, France; UPEC, Laboratoire d'Investigation Clinique (LIC), EA 4393, Créteil F-94000, France; INSERM Clinical Investigation Centre 006, Paris F-75000, France; Department of Clinical research and Public Health, Clinical Investigation Centre 006, Paris F-75000, France.
authors: Florence
authors: F
authors: Canouï-Poitrine
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017286:Polysomnography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012737:Sex Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000209:etiology*
keywords: Heart failure; Polygraphy; Score; Sensitivity; Sleep-disordered breathing (SDB); Specificity