Screening for Severe Obstructive Sleep Apnea Syndrome in Hypertensive Outpatients

Details

• Alternative Title:
  J Clin Hypertens (Greenwich)
• Personal Author:
  Gurubhagavatula, Indira ; Fields, Barry G. ; Morales, Christian R ; Hurley, Sharon ; Pien, Grace W ; Wick, Lindsay C. ; Staley, Bethany A. ; Townsend, Raymond R ; Maislin, Greg
• 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.
• Subjects:
  Female Humans Hypertension Male Mass Screening Middle Aged Outpatients Polysomnography Predictive Value Of Tests ROC Curve Severity Of Illness Index Sleep Apnea, Obstructive Symptom Assessment

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• Keywords:
  Home Sleep Testing Obstructive Sleep Apnea Syndrome
• Source:
  J Clin Hypertens (Greenwich). 15(4):279-288
• Pubmed ID:
  23551728
• Pubmed Central ID:
  PMC3621016
• Document Type:
  Journal Article
• Funding:
  T32 HL07713/HL/NHLBI NIH HHSUnited States/ ; R01-OH009149/OH/NIOSH CDC HHSUnited States/ ; T32 HL007713/HL/NHLBI NIH HHSUnited States/ ; K23 RR16068/RR/NCRR NIH HHSUnited States/ ; K23 RR016068/RR/NCRR NIH HHSUnited States/
• Volume:
  15
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ca860d0abcc47ff73ec2f1eea05fb8877119c377e9a7393a8ea724f1eaf6ab55
• Download URL:
  https://stacks.cdc.gov/view/cdc/29639/cdc_29639_DS1.pdf
• File Type:
  [PDF - 2.05 MB ]