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Sleep Apnea Clinical Score, Berlin Questionnaire, or Epworth Sleepiness Scale: which is the best obstructive sleep apnea predictor in patients with COPD?

Faria AC, da Costa CH, Rufino R - Int J Gen Med (2015)

Bottom Line: Fourteen patients (15.4%) had a high probability of OSA by SACS, 32 (32.5%) had a high probability by BQ, and 37 (40.7%) had excessive diurnal somnolence according to the ESS.From the 24 patients who underwent PSG, OSA diagnosis was confirmed in five (20.8%), according to the American Academy of Sleep Medicine criteria.SACS performance was significantly better, with an area under the curve of 0.82 (95% CI: 0.606-0.943, P=0.02).

View Article: PubMed Central - PubMed

Affiliation: Cardiopulmonology Department, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

ABSTRACT

Introduction: The Sleep Apnea Clinical Score (SACS) and the Berlin Questionnaire (BQ) are used to predict the likelihood of obstructive sleep apnea (OSA). The Epworth Sleepiness Scale (ESS) is used to assess daytime sleepiness, a common OSA symptom. These clinical tools help prioritize individuals with the most severe illness regarding on whom polysomnography (PSG) should be performed. It is necessary to check the applicability of these tools in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to compare SACS, BQ, and ESS performance in patients with COPD.

Methods: The SACS, BQ, and ESS were applied to 91 patients with COPD. From this group, 24 underwent PSG. In this transversal study, these three tests were compared regarding their likelihood to predict OSA in patients with COPD using receiver-operating characteristic curve statistics.

Results: In this sample, 58 (63.7%) patients were men, and their mean age was 69.4±9.6 years. Fourteen patients (15.4%) had a high probability of OSA by SACS, 32 (32.5%) had a high probability by BQ, and 37 (40.7%) had excessive diurnal somnolence according to the ESS. From the 24 patients who underwent PSG, OSA diagnosis was confirmed in five (20.8%), according to the American Academy of Sleep Medicine criteria. BQ and ESS did not accurately predict OSA in this group of patients with COPD, with a receiver-operating characteristic curve area under the curves of 0.54 (95% CI: 0.329-0.745, P=0.75) and 0.69 (95% CI: 0.47-0.860, P=0.10), respectively. SACS performance was significantly better, with an area under the curve of 0.82 (95% CI: 0.606-0.943, P=0.02).

Conclusion: SACS was better than BQ and ESS in predicting OSA in this group of patients with COPD.

No MeSH data available.


Related in: MedlinePlus

ROC curves for SACS, BQ, and ESS.Abbreviations: BQ, Berlin Questionnaire; ESS, Epworth Sleepiness Scale; ROC, receiver-operating characteristic; SACS, Sleep Apnea Clinical Score.
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f2-ijgm-8-275: ROC curves for SACS, BQ, and ESS.Abbreviations: BQ, Berlin Questionnaire; ESS, Epworth Sleepiness Scale; ROC, receiver-operating characteristic; SACS, Sleep Apnea Clinical Score.

Mentions: For the 24 participants who underwent PSG, we constructed ROC curves of SACS, BQ, and ESS. Table 3 shows sensitivity, specificity, positive predictive value, negative predictive value, and AUC of each questionnaire. Both BQ and ESS were poor at predicting or ruling out OSA, with AUCs of 0.542 (95% CI: 0.329–0.745; P=0.75) and 0.689 (95% CI: 0.470–0.860; P=0.10), respectively, while SACS had an AUC of 0.816 (95% CI: 0.606–0.943; P=0.02). SACS was significantly better than BQ in screening patients with COPD for OSA, with a difference between the areas of 0.274 (P=0.04). ROC curves for SACS, BQ, and ESS are shown in Figure 2. ROC statistics recommended a cutoff >11 points for SACS and >10 points for ESS.


Sleep Apnea Clinical Score, Berlin Questionnaire, or Epworth Sleepiness Scale: which is the best obstructive sleep apnea predictor in patients with COPD?

Faria AC, da Costa CH, Rufino R - Int J Gen Med (2015)

ROC curves for SACS, BQ, and ESS.Abbreviations: BQ, Berlin Questionnaire; ESS, Epworth Sleepiness Scale; ROC, receiver-operating characteristic; SACS, Sleep Apnea Clinical Score.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554480&req=5

f2-ijgm-8-275: ROC curves for SACS, BQ, and ESS.Abbreviations: BQ, Berlin Questionnaire; ESS, Epworth Sleepiness Scale; ROC, receiver-operating characteristic; SACS, Sleep Apnea Clinical Score.
Mentions: For the 24 participants who underwent PSG, we constructed ROC curves of SACS, BQ, and ESS. Table 3 shows sensitivity, specificity, positive predictive value, negative predictive value, and AUC of each questionnaire. Both BQ and ESS were poor at predicting or ruling out OSA, with AUCs of 0.542 (95% CI: 0.329–0.745; P=0.75) and 0.689 (95% CI: 0.470–0.860; P=0.10), respectively, while SACS had an AUC of 0.816 (95% CI: 0.606–0.943; P=0.02). SACS was significantly better than BQ in screening patients with COPD for OSA, with a difference between the areas of 0.274 (P=0.04). ROC curves for SACS, BQ, and ESS are shown in Figure 2. ROC statistics recommended a cutoff >11 points for SACS and >10 points for ESS.

Bottom Line: Fourteen patients (15.4%) had a high probability of OSA by SACS, 32 (32.5%) had a high probability by BQ, and 37 (40.7%) had excessive diurnal somnolence according to the ESS.From the 24 patients who underwent PSG, OSA diagnosis was confirmed in five (20.8%), according to the American Academy of Sleep Medicine criteria.SACS performance was significantly better, with an area under the curve of 0.82 (95% CI: 0.606-0.943, P=0.02).

View Article: PubMed Central - PubMed

Affiliation: Cardiopulmonology Department, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

ABSTRACT

Introduction: The Sleep Apnea Clinical Score (SACS) and the Berlin Questionnaire (BQ) are used to predict the likelihood of obstructive sleep apnea (OSA). The Epworth Sleepiness Scale (ESS) is used to assess daytime sleepiness, a common OSA symptom. These clinical tools help prioritize individuals with the most severe illness regarding on whom polysomnography (PSG) should be performed. It is necessary to check the applicability of these tools in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to compare SACS, BQ, and ESS performance in patients with COPD.

Methods: The SACS, BQ, and ESS were applied to 91 patients with COPD. From this group, 24 underwent PSG. In this transversal study, these three tests were compared regarding their likelihood to predict OSA in patients with COPD using receiver-operating characteristic curve statistics.

Results: In this sample, 58 (63.7%) patients were men, and their mean age was 69.4±9.6 years. Fourteen patients (15.4%) had a high probability of OSA by SACS, 32 (32.5%) had a high probability by BQ, and 37 (40.7%) had excessive diurnal somnolence according to the ESS. From the 24 patients who underwent PSG, OSA diagnosis was confirmed in five (20.8%), according to the American Academy of Sleep Medicine criteria. BQ and ESS did not accurately predict OSA in this group of patients with COPD, with a receiver-operating characteristic curve area under the curves of 0.54 (95% CI: 0.329-0.745, P=0.75) and 0.69 (95% CI: 0.47-0.860, P=0.10), respectively. SACS performance was significantly better, with an area under the curve of 0.82 (95% CI: 0.606-0.943, P=0.02).

Conclusion: SACS was better than BQ and ESS in predicting OSA in this group of patients with COPD.

No MeSH data available.


Related in: MedlinePlus