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Evaluation and validation of four translated Chinese questionnaires for obstructive sleep apnea patients in Hong Kong

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Abstract

Background

The present study validates and evaluates the sensitivity and specificity of four internationally popular questionnaires, translated into Chinese, for assessing suspected obstructive sleep apnea (OSA) patients, namely, the Berlin questionnaire, the ASA checklist, the STOP questionnaire and the STOP–BANG questionnaire. Their predictive values in OSA risks in patients presenting with OSA symptoms are examined. Questionnaires may be helpful in prioritizing polysomnography (PSG) and in treatment for the more severe cases.

Methods

All patients attending our sleep laboratory for overnight PSG were recruited. They were asked to complete three questionnaires (Berlin, ASA checklist and STOP) 2 weeks before and on the same night as the PSG. STOP–BANG questionnaire, an extended STOP with demographic data, ‘B’-body mass index (BMI), ‘A’-age, ‘N’-neck circumference and ‘G’-gender was completed by our technologists using the patient’s completed STOP.

Results

A number of 141 patients were recruited. The sensitivities and specificities for STOP–BANG with cutoffs at PSG’s RDI = 5, RDI = 15 and RDI = 30 were 81 % to 86 % and 34 % to 57 %, respectively. The high-risk group patients identified by STOP–BANG had significantly higher respiratory disturbance index and lower minimum oxygen saturation than the low-risk group patients.

Conclusion

Among the four questionnaires studied, STOP–BANG, with only eight questions and the highest sensitivity, is the best questionnaire of the four for OSA screening. This can potentially assist in prioritizing PSG and can be helpful in clinical or self-evaluation by the general public.

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Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Kowloon East Cluster, Hong Kong, China

    Stanley Ching Nam Ha, Dennis Lip Yen Lee & Victor James Abdullah

  2. Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong, China

    Dennis Lip Yen Lee, Victor James Abdullah & Charles Andrew van Hasselt

Authors
  1. Stanley Ching Nam Ha
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  2. Dennis Lip Yen Lee
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  3. Victor James Abdullah
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  4. Charles Andrew van Hasselt
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Corresponding author

Correspondence to Charles Andrew van Hasselt.

Appendices

Appendix 1 Berlin questionnaire

請於每條問題選擇最合適的答案

第一部分

  1. 1.

    您有没有打鼾?

    1. a.

      有

    2. b.

      没有

    3. c.

      不知道

如有打鼾,請回答第2-5條問題:

  1. 2.

    您的打鼾是:

    1. a.

      較呼吸稍微響亮

    2. b.

      跟說話時一樣響亮

    3. c.

      較說話時響亮

    4. d.

      很響亮--鄰近房間也能聽得到

  2. 3.

    您打鼾次數有多頻密?

    1. a.

      接近每一日都有

    2. b.

      每星期3-4 次

    3. c.

      每星期1-2次

    4. d.

      每月1-2次

    5. e.

      没有或接近没有

  3. 4.

    您打鼾有没有曾經使別人感到不安?

    1. a.

      有

    2. b.

      没有

    3. c.

      不知道

  4. 5.

    有没有人察覺您睡眠時停止呼吸?

    1. a.

      接近每一日都有

    2. b.

      每星期3-4 次

    3. c.

      每星期1-2次

    4. d.

      每月1-2次

    5. e.

      没有或接近没有

第二部分

  1. 6.

    您睡眠後感到疲倦或疲勞的次數有多頻密?

    1. a.

      接近每一日都有

    2. b.

      每星期3-4 次

    3. c.

      每星期1-2次

    4. d.

      每月1-2次

    5. e.

      没有或接近没有

  2. 7.

    在你剛醒來的時候,有没有感到疲倦、疲勞或不在平常的狀態?

    1. a.

      接近每一日都有

    2. b.

      每星期3-4 次

    3. c.

      每星期1-2次

    4. d.

      每月1-2次

    5. e.

      没有或接近没有

  3. 8.

    當駕駛車輛時 , 您有没有曾經打盹或睡着?

    1. a.

      有

    2. b.

      没有或没有駕車

如有,請回答第9條問題:

  1. 9.

    發生次數有多頻密?

    1. a.

      接近每一日都有

    2. b.

      每星期3-4 次

    3. c.

      每星期1-2次

    4. d.

      每月1-2次

    5. e.

      没有或接近没有

第三部分

  1. 10.

    您有没有高血壓?

    1. a.

      有

    2. b.

      没有

    3. c.

      不知道

Scoring

  1. Category 1:

    Items 1, 2, 3, 4, 5

    1. Item 1:

      If ‘Yes’, assign 1 point

    2. Item 2:

      If ‘c’ or ‘d’ is the response, assign 1 point

    3. Item 3:

      If ‘a’ or ‘b’ is the response, assign 1 point

    4. Item 4:

      If ‘a’ is the response, assign 1 point

    5. Item 5:

      If ‘a’ or ‘b’ is the response, assign 2 points

Add points. Category 1 is positive if the total score is 2 or more points

  1. Category 2:

    Items 6, 7, 8 (item 9 should be noted separately)

    1. Item 6:

      If ‘a’ or ‘b’ is the response, assign 1 point

    2. Item 7:

      If ‘a’ or ‘b’ is the response, assign 1 point

    3. Item 8:

      If ‘a’ is the response, assign 1 point

Add points. Category 2 is positive if the total score is 2 or more points

  • Category 3 is positive if the answer to item 10 is ‘Yes’ or if the BMI of the patient is greater than 30 kg/m2

    High-risk group:

    If there are two or more categories where the score is positive

    Low-risk group:

    If there is only one or no categories where the score is positive

Appendix 2 ASA checklist

如果您有/是以下所列 , 請在空格上加 √

第一部分: 已有的身體物理特性 (由醫生填寫)

  • □ 身體質量指數35 公斤/米2

  • □ 頸圓周 > 43 厘米/17 寸 (男性) 或 40厘米/16寸 (女性)

  • □ 不正常的面顱骨影響呼吸道

  • □ 結構上 (解剖學) 的鼻塞

  • □ 扁桃腺接近碰到或碰到中線

第二部分: 睡眠時明顯呼吸道阻塞的過往經歷

  • □ 打鼾 (連關門後 , 在外面也能聽到打鼾的聲音)

  • □ 經常也有打鼾

  • □ 被察覺睡眠時停止呼吸

  • □ 因有窒息的感覺而醒來

  • □ 經常也會覺醒

第三部分: 睡意

  • □ 即使有足夠睡眠 , 也有經常感到有睡意或疲勞

  • □ 即使有足夠睡眠 , 也容易在非促進睡眠的環境中(例如: 看電視,閱讀,踩單車和駕車)睡着

  • □ [家長或老師評論孩童在白天昏昏欲睡,容易分散注意力,有過度侵犯行為或難於集中精神] *

  • □ [在慣常醒來的時間,孩童很困難被喚起] *

*只適用於孩童的病人

Scoring

  • If two or more items in category 1 are positive, category 1 is positive

  • If two or more items in category 2 are positive, category 2 is positive

  • If two or more items in category 3 are positive, category 3 is positive

High-risk group::

Two or more categories scored as positive

Low-risk group::

Only one or no category scored as positive

Appendix 3 STOP questionnaire

如果您有/是以下所列 , 請在空格上加 √

  1. 1.

    您有没有打鼾 (連關門後 , 在外面也能聽到打鼾的聲音)? □

  2. 2.

    您在白天有没有疲倦 、疲勞或昏昏欲睡的感覺? □

  3. 3.

    您有没有患上高血壓或正接受高血壓的治療? □

  4. 4.

    有没有人察覺您睡眠時停止呼吸? □

Scoring

High risk of OSA::

√ in two or more questions

Low risk of OSA::

√ in less than two questions

Appendix 4 STOP–BANG questionnaire

如果您有/是以下所列 , 請在空格上加 √

  1. 1.

    您有没有打鼾 (連關門後 , 在外面也能聽到打鼾的聲音)? □

  2. 2.

    您在白天有没有疲倦 、疲勞或昏昏欲睡的感覺? □

  3. 3.

    您有没有患上高血壓或正接受高血壓的治療? □

  4. 4.

    有没有人察覺您睡眠時停止呼吸? □

  5. 5.

    身高體重指數 (BMI) > 30 公斤/米2 □

  6. 6.

    年齡 > 50 歲 □

  7. 7.

    頸圓周 > 40 厘米 □

  8. 8.

    性別是男性 □

Scoring

High risk of OSA::

√ in three or more items

Low risk of OSA::

√ in less than three items

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Ha, S.C.N., Lee, D.L.Y., Abdullah, V.J. et al. Evaluation and validation of four translated Chinese questionnaires for obstructive sleep apnea patients in Hong Kong. Sleep Breath 18, 715–721 (2014). https://doi.org/10.1007/s11325-013-0889-1

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  • DOI: https://doi.org/10.1007/s11325-013-0889-1

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