Open AccessScreening for Severe Obstructive Sleep Apnea Syndrome in Hypertensive Outpatients
Author(s) -
Gurubhagavatula Indira,
Fields Barry G.,
Morales Christian R,
Hurley Sharon,
Pien Grace W,
Wick Lindsay C.,
Staley Bethany A.,
Townsend Raymond R,
Maislin Greg
Publication year - 2013
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12073
Subject(s) - medicine , obstructive sleep apnea , polysomnography , receiver operating characteristic , gold standard (test) , sleep apnea , area under the curve , stage (stratigraphy) , prospective cohort study , physical therapy , apnea , cardiology , paleontology , biology
The authors attempted to validate a 2‐stage strategy to screen for severe obstructive sleep apnea syndrome (s‐ OSAS ) among hypertensive outpatients, with polysomnography ( PSG ) as the gold standard. Using a prospective design, outpatients with hypertension were recruited from medical outpatient clinics. Interventions included (1) assessment of clinical data; (2) home sleep testing ( HST ); and (3) 12‐channnel, in‐laboratory PSG . The authors developed models using clinical or HST data alone (single‐stage models) or clinical data in tandem with HST (2‐stage models) to predict s‐ OSAS . For each model, area under receiver operating characteristic curves ( AUCs ), sensitivity, specificity, negative likelihood ratio, and negative post‐test probability ( NPTP ) were computed. Models were then rank‐ordered based on AUC values and NPTP . HST used alone had limited accuracy ( AUC =0.727, NPTP =2.9%). However, models that used clinical data in tandem with HST were more accurate in identifying s‐ OSAS , with lower NPTP : (1) facial morphometrics ( AUC =0.816, NPTP =0.6%); (2) neck circumference ( AUC =0.803, NPTP =1.7%); and Multivariable Apnea Prediction Score ( AUC =0.799, NPTP =1.5%) where sensitivity, specificity, and NPTP were evaluated at optimal thresholds. Therefore, HST combined with clinical data can be useful in identifying s‐ OSAS in hypertensive outpatients, without incurring greater cost and patient burden associated with in‐laboratory PSG . These models were less useful in identifying obstructive sleep apnea syndrome of any severity.