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Screening for severe obstructive sleep apnea syndrome in hypertensive outpatients.

Authors
Gurubhagavatula-I; Fields-BG; Morales-CR; Hurley-S; Pien-GW; Wick-LC; Staley-BA; Townsend-RR; Maislin-G
Source
J Clin Hypertens 2013 Apr; 15(4):279-288
NIOSHTIC No.
20043361
Abstract
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.
Keywords
Medical-screening; Sleep-disorders; Outpatient-facilities; Hypertension; Health-care; Health-services; Health-standards; Clinical-tests; Laboratory-testing; Analytical-models; Analytical-instruments
Contact
Barry G. Fields, MD, Center for Sleep and Circadian Neurobiology, 3624 Market Street, Suite 205, Philadelphia, PA 19104
CODEN
JCHYEM
Publication Date
20130401
Document Type
Journal Article
Email Address
barry.fields@uphs.upenn.edu
Funding Type
Grant
Fiscal Year
2013
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-009149; M112013
Issue of Publication
4
ISSN
0748-450X
Source Name
Journal of Clinical Hypertension
State
PA
Performing Organization
University of Pennsylvania
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