title: During economic crisis can sleep questionnaires improve the value of oximetry for assessing sleep apnea?
abstract: BACKGROUND
  The diagnosis of obstructive sleep apnea/hypopnea syndrome (OSAHS) is essential but polysomnography (PSG) is expensive and time consuming. Oximetry has been used as a less expensive indicator of OSAHS. The aim of the study was to evaluate the clinical utility of the combination of oximetry with four different questionnaires: Stop, Stop Bang (S-B), Berlin questionnaire (BQ), Epworth Sleepiness Scale (ESS) in order to identify patients at risk for OSAHS compared with in-laboratory PSG.
  
  
  METHODS
  Patients visiting a sleep clinic were prospectively studied. They completed Stop, S-B, BQ and ESS. Home oximetry and in laboratory PSG were performed within 3-20 days.
  
  
  RESULTS
  A total of 204 patients were included in the study (77.5% males, mean age 51.8±13.8 years, BMI 32.8±6.2 kg/m2, SaO2% awake 95.7±2). S-B had the highest sensitivity (Se) (97.5%) and negative predictive value (NPV) (62.5%) but the lowest specificity (Sp) (9%), whereas ESS had the best Sp (75%) and positive predictive values (PPV) (81.4%). The predictive values of questionnaires improved as the severity of OSAHS worsened. The predictive values of oximetry were high for severe but low for mild and moderate OSAHS. For that oximetry was combined with different sleep questionnaires in different OSAHS severity groups, but with no improvement in the predictive values.
  
  
  CONCLUSIONS
  Oximetry may be used as a tool for identifying severe OSAHS. For mild and moderate disease the combination of questionnaires did not improve the diagnostic accuracy and especially for symptomatic patients with negative results, the need of PSG is essential.
authors.affiliation: Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Athanasia
authors.initials: A
authors.lastname: Pataka
authors.affiliation: Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Paul
authors.initials: P
authors.lastname: Zarogoulidis
authors.affiliation: Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hohenforst-Schmidt
authors.affiliation: Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Theodora
authors.initials: T
authors.lastname: Tsiouda
authors.affiliation: Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Drosos
authors.initials: D
authors.lastname: Tsavlis
authors.affiliation: Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kioumis
authors.affiliation: Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Elene
authors.initials: E
authors.lastname: Papakala
authors.affiliation: Ear, Nose and Throat Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece.
authors.forename: Ilias
authors.initials: I
authors.lastname: Karapantzos
authors.affiliation: Ear, Nose and Throat Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece.
authors.forename: Chrysa
authors.initials: C
authors.lastname: Karapantzou
authors.affiliation: Second Pulmonary Clinic, "Sotiria" Chest Diseases Hospital, Athens 11527, Greece.
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Rapti
authors.affiliation: Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Kosmas
authors.initials: K
authors.lastname: Tsakiridis
authors.affiliation: Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zarogoulidis
authors.affiliation: Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Parakevi
authors.initials: P
authors.lastname: Argyropoulou
keywords: Berlin questionnaire (BQ); Epworth Sleepiness Scale (ESS); Oximetry; Stop; Stop-Bang (S-B); sleep apnea