Yonsei Med J.  2015 May;56(3):684-690. 10.3349/ymj.2015.56.3.684.

The Utility of Three Screening Questionnaires for Obstructive Sleep Apnea in a Sleep Clinic Setting

• Kim B
• Lee EM
• Chung YS
• Kim WS
• Lee SA

• KMID: 2450341
• DOI: http://doi.org/10.3349/ymj.2015.56.3.684

Abstract

PURPOSE
The aim of this study was to determine the diagnostic value of three screening questionnaires in identifying Korean patients at high risk for obstructive sleep apnea (OSA) in a sleep clinic setting in Korea.
MATERIALS AND METHODS
Data were collected from 592 adult patients with suspected OSA who visited a sleep center. All patients completed the Sleep Apnea of Sleep Disorder Questionnaire (SA-SDQ), the Berlin questionnaire, and the STOP-Bang questionnaire. Estimated OSA risk was compared to a diagnosis of OSA. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each questionnaire.
RESULTS
The prevalence of OSA was 83.6% using an apnea-hypopnea index (AHI) > or =5/h and 58.4% for an AHI > or =15/h. The STOP-Bang questionnaire had a high sensitivity (97% for AHI > or =5/h, 98% for AHI > or =15/h), but the specificity was low (19% and 11%, respectively). In contrast, the sensitivity of the SA-SDQ was not high enough (68% for AHI > or =5/h, 74% for AHI > or =15/h) to be useful in a clinical setting, whereas the specificity was relatively good (66% and 61%, respectively). The sensitivity and specificity values of the Berlin questionnaire fell between those of the STOP-Bang questionnaire and the SA-SDQ.
CONCLUSION
The STOP-Bang questionnaire may be useful for screening OSA in a sleep clinic setting, but its specificity is lower than the acceptable level for this purpose. A new screening questionnaire with a high sensitivity and acceptable specificity is therefore needed in a sleep clinic setting.

Keyword

Obstructive sleep apnea; screening questionnaires; sleep disorders

MeSH Terms

Adult
Asian Continental Ancestry Group/*statistics & numerical data
Female
Humans
Male
Mass Screening/*methods
Middle Aged
Polysomnography/methods
Predictive Value of Tests
Prevalence
*Questionnaires
ROC Curve
Reproducibility of Results
Republic of Korea/epidemiology
Sensitivity and Specificity
Severity of Illness Index
Sleep Apnea, Obstructive/*diagnosis/ethnology

Figure

• 

  Fig. 1 Receiver-operator characteristic (ROC) curves for the SA-SDQ for an AHI cutoff of ≥5/hour and ≥15/hour. The ROC curve is a graphical plot displaying the ability to distinguish between subjects with and without a disease. Overall accuracy of the ROC curve is expressed as the area under the ROC curve (AUC), which ranges between 0 and 1. The closer AUC to 1, the better the overall diagnostic accuracy of the test. The AUC is given in the legend of each graph. SA-SDQ, Sleep Apnea of Sleep Disorder Questionnaire; AHI, apnea-hypopnea index.

Reference

1. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002; 162:893–900.

2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328:1230–1235.

3. Nam H, Yang HJ, Kim YA, Kim HC. Impact of chronic simulated snoring on carotid atherosclerosis in rabbits. J Clin Neurol. 2013; 9:269–273.

4. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001; 163:19–25.

5. Yun CH, Jung KH, Chu K, Kim SH, Ji KH, Park HK, et al. Increased circulating endothelial microparticles and carotid atherosclerosis in obstructive sleep apnea. J Clin Neurol. 2010; 6:89–98.

6. Ahn SH, Kim JH, Kim DU, Choo IS, Lee HJ, Kim HW. Interaction between Sleep-Disordered Breathing and Acute Ischemic Stroke. J Clin Neurol. 2013; 9:9–13.

7. Litvin AY, Sukmarova ZN, Elfimova EM, Aksenova AV, Galitsin PV, Rogoza AN, et al. Effects of CPAP on "vascular" risk factors in patients with obstructive sleep apnea and arterial hypertension. Vasc Health Risk Manag. 2013; 9:229–235.

8. Noda A, Miyata S, Yasuda Y. Therapeutic strategies for sleep apnea in hypertension and heart failure. Pulm Med. 2013; 2013:814169.

9. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005; 28:499–521.

10. Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth. 2010; 57:423–438.

11. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008; 108:812–821.

12. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999; 131:485–491.

13. Ahmadi N, Chung SA, Gibbs A, Shapiro CM. The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath. 2008; 12:39–45.

14. Ong TH, Raudha S, Fook-Chong S, Lew N, Hsu AA. Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population. Sleep Breath. 2010; 14:371–376.

15. Kang K, Seo JG, Seo SH, Park KS, Lee HW. Prevalence and related factors for high-risk of obstructive sleep apnea in a large Korean population: results of a questionnaire-based study. J Clin Neurol. 2014; 10:42–49.

16. Douglass AB, Bornstein R, Nino-Murcia G, Keenan S, Miles L, Zarcone VP Jr, et al. The Sleep Disorders Questionnaire. I: Creation and multivariate structure of SDQ. Sleep. 1994; 17:160–167.

17. Iber C, Ancoli-Israel S, Chesson AL Jr, Auan SF. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL: American Academy of Sleep Medicine;2007. p. 45–50.

18. Vana KD, Silva GE, Goldberg R. Predictive abilities of the STOP-Bang and Epworth Sleepiness Scale in identifying sleep clinic patients at high risk for obstructive sleep apnea. Res Nurs Health. 2013; 36:84–94.

19. Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess. 1998; 2:i–iv. 1–74.

20. Lam B, Lam DC, Ip MS. Obstructive sleep apnoea in Asia. Int J Tuberc Lung Dis. 2007; 11:2–11.

21. Lam B, Ip MS, Tench E, Ryan CF. Craniofacial profile in Asian and white subjects with obstructive sleep apnoea. Thorax. 2005; 60:504–510.

22. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008; 108:822–830.

23. Weatherwax KJ, Lin X, Marzec ML, Malow BA. Obstructive sleep apnea in epilepsy patients: the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) is a useful screening instrument for obstructive sleep apnea in a disease-specific population. Sleep Med. 2003; 4:517–521.