Abstract
Background
Reducing the need for diagnostic sleep studies for obstructive sleep apnea (OSA) would reduce direct and opportunity costs while expediting time to treatment for this common and morbid disorder. We sought to determine if an established sleep apnea screening questionnaire (STOP-BANG) and wrist-worn overnight oximetry data could provide high positive predictive value for the presence of OSA.
Methods
We conducted a prospective observational study of consecutive unattended sleep study patients at a single facility. Patients were referred for sleep testing after chart review by a sleep physician. We assessed area under the receiver-operating characteristic curve (ROC AUC) and positive predictive value (PPV) of STOP-BANG score and oxygen desaturation index (ODI) for a respiratory disturbance index (RDI) ≥15/h.
Results
Among 234 test patients, 65 % had an RDI ≥15/h. STOP-BANG had poor ability to discriminate these patients (ROC AUC 0.62). ODI added significant diagnostic information to the STOP-BANG score, increasing the ROC AUC to 0.86. Having the ODI, the STOP-BANG score no longer contributed significant diagnostic information, and the ODI alone discriminated as well as the combination (ROC AUC 0.86). Forty nine percent had an ODI ≥7/h, which had PPV of 92 % (95 % confidence interval (CI), 86 to 96 %). In the validation sample of 1,196 consecutive patients, ODI ≥ 7/h had a PPV of 97 % (95 % CI, 95 to 97 %).
Conclusions
Among patients with a high prevalence of OSA, high ODI is common and its presence has high PPV for OSA. These data suggest that overnight oximetry prior to sleep testing could significantly reduce the number of patients requiring sleep studies, thereby reducing costs and time to treatment.
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Abbreviations
- BMI:
-
Body mass index
- CPAP:
-
Continuous positive airway pressure
- HST:
-
Home sleep test
- ODI:
-
Oxygen desaturation index
- OSA:
-
Obstructive sleep apnea
- PAT:
-
Peripheral arterial tonometry
- PPV:
-
Positive predictive value
- PSG:
-
Polysomnogram
- RDI:
-
Respiratory disturbance index
- ROC AUC:
-
Receiver-operating characteristic area under curve
- VA:
-
Veterans Affairs
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Acknowledgments
This study supported by an Upper Midwest Veterans Integrated Service Network 23 Strategic Initiative Award. The funding agency had no role in design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; nor decision to submit the manuscript for publication. We thank the Veterans Integrated Service Network (VISN) 23 for supporting this project. We thank the Minneapolis VA Sleep Clinic staff for assistance with data collection, logistic support for this study, and for their dedication to the sleep health of veterans.
Conflict of interest
The authors declare that they have no competing interests.
Guarantor
KMK and TSR had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. The lead author KMK affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
Disclaimer
The views expressed in this article are those of the authors and do not necessarily represent the views of VISN 23, the Minneapolis VA Health Care System, the U.S. Department of Veterans Affairs, the U.S. Government, or the University of Minnesota.
Author contributions
KMK conceived and designed the study, directed the statistical analyses, interpreted the data, drafted the manuscript, and approved the final version.
OG contributed to collection and interpretation of the data, revised the manuscript critically for important intellectual content, and approved the final version.
EEW contributed to the conception and design of the study, contributed to interpretation of the data, revised the manuscript critically for important intellectual content, and approved the final version.
TSR contributed to the conception and design of the study, performed the statistical analyses, interpreted the data, revised the manuscript critically for important intellectual content, and approved the final version.
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Kunisaki, K.M., Bohn, O.A., Wetherbee, E.E. et al. High-resolution wrist-worn overnight oximetry has high positive predictive value for obstructive sleep apnea in a sleep study referral population. Sleep Breath 20, 583–587 (2016). https://doi.org/10.1007/s11325-015-1251-6
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DOI: https://doi.org/10.1007/s11325-015-1251-6