title: Sex-Specific Prediction Models for Sleep Apnea From the Hispanic Community Health Study/Study of Latinos.
abstract: OBJECTIVE
  We developed and validated the first-ever sleep apnea (SA) risk calculator in a large population-based cohort of Hispanic/Latino subjects.
  
  
  METHODS
  Cross-sectional data on adults from the Hispanic Community Health Study/Study of Latinos (2008-2011) were analyzed. Subjective and objective sleep measurements were obtained. Clinically significant SA was defined as an apnea-hypopnea index ≥ 15 events per hour. Using logistic regression, four prediction models were created: three sex-specific models (female-only, male-only, and a sex × covariate interaction model to allow differential predictor effects), and one overall model with sex included as a main effect only. Models underwent 10-fold cross-validation and were assessed by using the C statistic. SA and its predictive variables; a total of 17 variables were considered.
  
  
  RESULTS
  A total of 12,158 participants had complete sleep data available; 7,363 (61%) were women. The population-weighted prevalence of SA (apnea-hypopnea index ≥ 15 events per hour) was 6.1% in female subjects and 13.5% in male subjects. Male-only (C statistic, 0.808) and female-only (C statistic, 0.836) prediction models had the same predictor variables (ie, age, BMI, self-reported snoring). The sex-interaction model (C statistic, 0.836) contained sex, age, age × sex, BMI, BMI × sex, and self-reported snoring. The final overall model (C statistic, 0.832) contained age, BMI, snoring, and sex. We developed two websites for our SA risk calculator: one in English (https://www.montefiore.org/sleepapneariskcalc.html) and another in Spanish (http://www.montefiore.org/sleepapneariskcalc-es.html).
  
  
  CONCLUSIONS
  We created an internally validated, highly discriminating, well-calibrated, and parsimonious prediction model for SA. Contrary to the study hypothesis, the variables did not have different predictive magnitudes in male and female subjects.
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY. Electronic address: Neomi.Shah@mssm.edu.
authors.forename: Neomi
authors.initials: N
authors.lastname: Shah
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY.
authors.forename: David B
authors.initials: DB
authors.lastname: Hanna
authors.affiliation: University of North Carolina, Chapel Hill, NC.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Teng
authors.affiliation: University of North Carolina, Chapel Hill, NC.
authors.forename: Daniela
authors.initials: D
authors.lastname: Sotres-Alvarez
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Martica
authors.initials: M
authors.lastname: Hall
authors.affiliation: University of California San Diego, San Diego, CA.
authors.forename: Jose S
authors.initials: JS
authors.lastname: Loredo
authors.affiliation: Northwestern University, Chicago, IL.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Zee
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Mimi
authors.initials: M
authors.lastname: Kim
authors.affiliation: Yale School of Medicine, New Haven, CT.
authors.forename: H Klar
authors.initials: HK
authors.lastname: Yaggi
authors.affiliation: Harvard Medical School, Brigham and Woman's Hospital, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making / Q000379:methods; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D015233:Models, Statistical; D017286:Polysomnography / Q000379:methods / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology; D014481:United States / Q000453:epidemiology
keywords: clinical decision-making; community health; epidemiology (pulmonary); sex-specific prediction; sleep apnea
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