Questionnaire and Portable Sleep Test Screening of Sleep Disordered Breathing in Acute Stroke and TIA

Sleep disordered breathing (SDB) is highly prevalent, but frequently unrecognized among stroke patients. Polysomnography (PSG) is difficult to perform soon after a stroke. We evaluated the use of screening questionnaires and portable sleep testing (PST) for patients with acute stroke, subarachnoid hemorrhage, or transient ischemic attack to expedite SDB diagnosis and management. We performed a single-center retrospective analysis of a quality improvement study on SDB screening of consecutive daytime, weekday, adult admissions to a stroke unit. We excluded patients who were unable to communicate and lacked available family members. Patients were screened with the Epworth Sleepiness Scale, Berlin Questionnaire, and STOP-BANG Questionnaire and underwent overnight PST and/or outpatient PSG. The 4-item STOP Questionnaire was derived from STOP-BANG for a secondary analysis. We compared the sensitivity and specificity of the questionnaires for the diagnosis of at least mild SDB (apnea hypopnea index (AHI) ≥5) on PST and correlated AHI measurements between PST and PSG using the Spearman correlation. Out of sixty-eight patients included in the study, 54 (80%) were diagnosed with SDB. Only one (1.5%) had a previous SDB diagnosis. Thirty-three patients completed all questionnaires and a PST. The STOP-BANG questionnaire had the highest sensitivity for at least mild SDB (0.81, 95% CI (confidence interval): 0.65–0.92) but a low specificity (0.33, 95% CI 0.10, 0.65). The discrimination of all questionnaires was overall poor (C statistic range 0.502–0.640). There was a strong correlation (r = 0.71) between the AHI results estimated using PST and outpatient PSG among 28 patients. The 4-item STOP Questionnaire was the easiest to administer and had a comparable or better sensitivity than the other questionnaires. Inpatient PSTs were useful for screening in the acute setting to facilitate an early diagnosis of SDB and to establish further outpatient evaluations with sleep medicine.

The importance of screening questionnaires in detecting the severity of obstructive sleep apnea

ntroduction: The aim of this study is to compare the importance of screening questionnaires and risk factors in detecting the severity of obstructive sleep apnea (OSA). Methods: The study included 47 patients with suspected OSA. The patients completed 5 screening questionnaires – the Epworth Sleepiness Scale (ESS), the STOP BANG questionnaire, the STOP questionnaire, the Berlin questionnaire (BQ) and the Pittsburgh Sleep Quality Index (PSQI). Subsequently, they were examined by the limited polygraphy. AHI (number of apneas/ hypopneas per 1 hour), t90 desaturation (percentage of sleep time spent in desaturations below 90%) and ODI (number of desaturations ≥ 3% within 1 hour) were compared with questionnaire scores and selected risk factors for OSA (BMI, male gender, hypertension, age, neck circumference, abdominal circumference and abdominal/ hip circumference ratio). Results: The achieved score of any of the monitored questionnaires does not correlate with the value of AHI. BQ, STOP and STOP BANG questionnaires have the relatively highest sensitivity for OSA detection, while the sensitivity of PSQI and ESS is low. The correlation of the ESS, STOP BANG and BQ scores with the t90 desaturation, as well as the ESS and STOP BANG scores with the ODI is statistically signifi cant. The relationship of any of the selected risk factors with the AHI value has not been demonstrated. Desaturation values of t90 and ODI correlated best with BMI, neck circumference and abdominal/ hip circumference ratio. Conclusion: None of the monitored questionnaires is suitable for determining the severity of OSA, it is always necessary to perform a polygraphic or polysomnographic examination of sleep. BQ and STOPBANG are relatively most suitable for OSA screening. They both have high sensitivity and, at the same time, their score correlates with the value of nocturnal hypoxemia. Parameters measuring nocturnal hypoxemia (t90 desaturation, ODI) correlate better with risk factors than AHI. The most important parameters associated with hypoxemia are BMI, neck circumference and abdominal/ hip circumference ratio and it is appropriate to include them in the screening for OSA. Keywords: obstructive sleep apnea – Berlin questionnaire – STOP-Bang questionnaire – STOP questionnaire – Epworth sleepiness scale – Pittsburgh Sleep Quality Index

400 Utility of the STOP Questionnaire in Predicting Sleep Disordered Breathing in Older Women Veterans

Introduction Sleep disordered breathing (SDB) is underdiagnosed in older women, despite a significant increase in SDB prevalence post-menopause. Few studies have assessed the diagnostic accuracy of SDB screening questionnaires in older women, particularly older Women Veterans (WV). WV have higher rates of SDB compared to non-Veteran women and are particularly vulnerable to sleep disorders in general. We examined the diagnostic accuracy of the STOP questionnaire compared to home sleep apnea testing (HSAT) that includes sleep time estimation (i.e., WatchPAT) in older WV. Methods Cross-sectional baseline data obtained from chart review were combined from two behavioral sleep intervention studies targeting WV with sleep difficulties (i.e., insomnia symptoms) or SDB risk factors (e.g., hypertension, obesity). A total of 136 older WV (50-91y; age=60.0±7.8y) completed the STOP questionnaire (yes/no: snoring, tiredness, observed breathing pauses, and high blood pressure [BP]) and had an apnea-hypopnea index (AHI) available from their baseline HSAT (WatchPAT). Sensitivity, specificity, and positive and negative likelihood ratios (+LR/-LR) were calculated to characterize the diagnostic accuracy of STOP≥2 for AHI≥5 (mild SDB) or AHI≥15 (moderate SDB). Results 70.6% (n=96) of participants endorsed a STOP≥2, 83.8% (n=114) demonstrated an AHI≥5 and 46.3% (n=63) demonstrated an AHI≥15. For AHI≥5, sensitivity was 73.7% (95% CI=64.6,81.5%), specificity was 45.5% (95% CI=24.4,67.8%), +LR was 1.35 (95% CI=0.91, 2.01), and -LR was 0.58 (95% CI=0.33,1.00). For AHI≥15, sensitivity was 76.2% (95% CI=63.8,86%), specificity was 34.2% (95% CI=23.5,46.3%), +LR was 1.16 (95% CI=0.93,1.44), and -LR was 0.70 (95% CI=0.30,1.20). Conclusion The likelihood ratios for STOP≥2 limited the utility of the STOP vs. an HSAT system with sleep scoring in determining AHI. While the STOP correctly identified 3/4 of older WV with SDB on WatchPAT, it correctly identified <50% of older WV without SDB. Screening measures that better capture predictors of moderate SDB in women at risk for SDB are needed, especially in older women who may not present clinically with the common SDB symptoms (i.e. snoring, tiredness, observed breathing pauses, and high BP). STOP compared to polysomnography studies are also needed. Support (if any) VA HSR&D IIR-13–058, IIR 16–244 and RCS 20–191; NIH/NHLBI K24 HL143055, VAGLAHS GRECC, VA Office of Academic Affiliations, and AASM Foundation.

Association between self-reported snoring, STOP questionnaire and post-operative pulmonary complications in patients submitted to ortophaedic surgery

Background: Obstructive sleep apnea (OSA) may increase perioperative complications. The aim of this study was to determine the relationship among postoperative pulmonary complication, snoring and STOP questionnaire in patients with ortophaedic surgery. Methods: 1,406 consecutive records of patients who had undergone elective ortophaedic surgery during the period January 2005-December 2008 were investigated retrospectively. Demographic information, sleep symptoms, STOP questionnaire, comorbidities and outcome data were collected. Results: There were 289 (20.5%) snorers and 1,117 (79.5%) non-snorers in the study group. There was no significant difference between snorer and non-snorer patients (p > 0.05) in the prevalence of pneumonia and respiratory failure. But in snorer patients the rate of postoperative atelectasis was significantly higher than in non-snorer group (p < 0.0001). The STOP Questionnaire was given to 1,406 patients and 147 (10.4%) out of them were classified at high risk of OSA. There was no significant difference in the prevalence of pneumonia and respiratory failure between low and high risk group (p > 0.05). However, in high risk patients the occurrence of postoperative atelectasis was significantly higher than in low risk group (p < 0.0001). Conclusion: Postoperative atelectasis was significantly more prevalent in the high risk group according to STOP questionnaire.