Screening for severe obstructive sleep apnea syndrome in hypertensive outpatients

Details

• Personal Author:
  Fields BG ; Gurubhagavatula I ; Hurley S ; Maislin G ; Morales CR ; Pien GW ; Staley BA ; Townsend RR ; Wick LC
• Description:
  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. [Description provided by NIOSH]
• Subjects:
  Cardiovascular Diseases Cardiovascular System Occupational Health Safety
• Keywords:
  Clinical Tests Health Care Hypertension Medical-screening Medical Screening Sleep Apnea
• ISSN:
  0748-450X
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  OSHA Region 3 ; Pennsylvania
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  279-288
• Volume:
  15
• Issue:
  4
• NIOSHTIC Number:
  nn:20043361
• Citation:
  J Clin Hypertens 2013 Apr; 15(4):279-288
• Contact Point Address:
  Barry G. Fields, MD, Center for Sleep and Circadian Neurobiology, 3624 Market Street, Suite 205, Philadelphia, PA 19104
• Email:
  barry.fields@uphs.upenn.edu
• Federal Fiscal Year:
  2013
• Performing Organization:
  University of Pennsylvania
• Peer Reviewed:
  True
• Start Date:
  20070801
• Source Full Name:
  Journal of Clinical Hypertension
• End Date:
  20130701
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:07c98e4196e2ed5e983204316bd49e09d3d3d68e3598df8b8a54dd1616ac584a138139caa0ce5930cc9497ec60a47008547cf23a85aa8cad8a54480172fc5698
• Download URL:
  https://stacks.cdc.gov/view/cdc/195278/cdc_195278_DS1.pdf
• File Type:
  [PDF - 427.75 KB ]