Sleep Apnea Clinical Score, Berlin Questionnaire, or Epworth Sleepiness Scale: which is the best obstructive sleep apnea predictor in patients with COPD?

Prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam

PURPOSE

Chronic obstructive pulmonary disease and obstructive sleep apnea are two common respiratory diseases. Chronic obstructive pulmonary disease patients co-morbid with obstructive sleep apnea are associated with increased cardiovascular adverse events, frequent acute exacerbations, and higher mortality. Only a few studies on obstructive sleep apnea among patients with chronic obstructive pulmonary disease are available in Vietnam. The study aims to determine the prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam.

METHODS

This is a cross-sectional study in patients with chronic obstructive pulmonary disease at multi-sites in Vietnam: the People's Hospital of Gia Dinh, Bach Mai Hospital, Phoi Viet Clinics, and Lam Dong Medical College using type 3 sleep monitoring device at sleep labs to diagnose obstructive sleep apnea in all study participants.

RESULTS

Two hundred seventy-eight patients with chronic obstructive pulmonary disease were enrolled. Among the patients, 93.2% were male, with an average age of 66.9 ± 9.3 and a BMI of 21.9 ± 3.8 kg/m2; 82.0% were symptomatic including 44.6% in group B and 37.4% in group D with average post-FEV1 of 49.8 ± 18.3% predicted values. One hundred seventeen patients (42.1%) with chronic obstructive pulmonary disease presented obstructive sleep apnea defined by AHI ≥ 15 events/h.

CONCLUSIONS

The prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam was 42.1% for an AHI of ≥ 15 events/h.

The Overlap Syndrome: A Combination of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea

Chronic obstructive pulmonary disease (COPD) is a severe lung disease that results in persistent and progressively worsening airflow obstruction due to abnormalities in the airway and alveoli. Obstructive sleep apnea (OSA) is a critical condition characterized by obstructive apneas, hypopneas, and respiratory effort-related arousals. These events occur due to the repetitive collapse of the upper airway during sleep, and it is essential to address this condition. These two conditions, when co-occur, are known as overlap syndrome (OS), which is associated with a higher likelihood of morbidity and mortality compared to either condition alone. Effective management of overlap syndrome is critical to maintain normal oxygen levels during sleep and reduce the incidence of hypoxemia and hypoventilation while improving sleep quality. Positive pressure ventilation is a standard technique used to effectively lower hospitalizations, emergency room visits, moderate and severe exacerbations, and related healthcare expenses in patients diagnosed with COPD and OSA. Despite the lack of literature on overlap syndrome, it is imperative to understand that this condition requires prompt and effective management to prevent further complications. Therefore, this review provides a detailed discussion highlighting the importance of proactive measures to manage overlap syndrome.

Review of the prevalence, pathogenesis and management of OSA-COPD overlap

PURPOSE

OSA-COPD overlap is an important and prevalent condition yet remains under-recognised among the vast majority of respiratory health professionals. Patients with OSA-COPD overlap experience more severe respiratory symptoms and worse quality of life, and the relative risk of exacerbations, hospitalisations, and mortality is higher than in either disease state alone.

METHODS

Electronic databases PUBMED and Google Scholar were searched for studies and academic papers that discussed OSA-COPD overlap. Relevant papers that discussed prevalence, pathophysiology, microbiome studies, treatment regimens and outcomes were included in this paper.

RESULTS

High-risk patients with either COPD or OSA should be screened for overlap syndrome as part of routine clinical practice. Screening questionnaires can identify high-risk patients with COPD who may benefit from formal polysomnography. Patients with OSA who are aged over 40 with a significant smoking history or environmental exposures have an increased pre-test probability of obstructive airway disease. The potential roles of gastro-oesophageal reflux disease and lung-gut microbiome are evolving and merit further investigation. A tailored approach to reach a timely diagnosis and thus optimisation of both conditions are key to management. CPAP is the primary therapy for OSA; however, patients with more advanced COPD, with daytime hypercapnia or severe nocturnal desaturations, may benefit from bilevel positive airway pressure.

CONCLUSION

Increased awareness, access to timely investigations and initiation of therapy will improve overall outcomes in OSA-COPD overlap by reducing hospitalisations for exacerbations of COPD and improve mortality rates.

A review of therapies for the overlap syndrome of obstructive sleep apnea and chronic obstructive pulmonary disease

Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are common chronic diseases. These two noncommunicable diseases (NCDs) are prevalent among approximately 10% of the general population. Approximately 1% of the population is affected by the co-existence of both conditions, known as the overlap syndrome (OS). OS patients suffer from greater degrees of nocturnal oxygen desaturation and cardiovascular consequences than those with either condition in isolation. Besides OS, patients with COPD may suffer from a spectrum of sleep-related breathing disorders, including hypoventilation and central sleep apnea. The article provides an overview of the pathogenesis, associated risk factors, prevalence, and management of sleep-related breathing disorders in COPD. It examines respiratory changes during sleep caused by COPD and OSA. It elaborates upon the factors that link the two conditions together to lead to OS. It also discusses the clinical evaluation and diagnosis of these patients. Subsequently, it reviews the pathophysiological basis and the current evidence for three potential therapies: positive airway pressure therapy [including continuous positive airway pressure (CPAP) and bilevel positive airway pressure], oxygen therapy, and pharmacological therapy. It also proposes a phenotypic approach toward the diagnosis and treatment of OS and the entire spectrum of sleep-related breathing disorders in COPD. It concludes with the current evidence gaps and future areas of research in the management of OS.

Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person

Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of life, mortality, falls and disease risk. Sleep assessment should form part of the comprehensive geriatric assessment. If sleep disturbance is brought to light, consideration of sleep disorders, co-morbidity and medication management should form part of a multifaceted approach. Appreciation of the bi-directional relationship and complex interplay between co-morbidity and sleep in older patients is an important element of patient care. This article provides a brief overview of sleep disturbance and sleep disorders in older patients, in addition to their association with specific co-morbidities including depression, heart failure, respiratory disorders, gastro-oesophageal reflux disease, nocturia, pain, Parkinson's disease, dementia, polypharmacy and falls. A potential systematic multidomain approach to assessment and management is outlined, with an emphasis on non-pharmacological treatment where possible.

Long-Term Noninvasive Ventilation in Chronic Stable Hypercapnic Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline

Background: Noninvasive ventilation (NIV) is used for patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnia. However, evidence for clinical efficacy and optimal management of therapy is limited.

Target Audience: Patients with COPD, clinicians who care for them, and policy makers.

Methods: We summarized evidence addressing five PICO (patients, intervention, comparator, and outcome) questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to evaluate the certainty in evidence and generate actionable recommendations. Recommendations were formulated by a panel of pulmonary and sleep physicians, respiratory therapists, and methodologists using the Evidence-to-Decision framework.

Recommendations:1) We suggest the use of nocturnal NIV in addition to usual care for patients with chronic stable hypercapnic COPD (conditional recommendation, moderate certainty); 2) we suggest that patients with chronic stable hypercapnic COPD undergo screening for obstructive sleep apnea before initiation of long-term NIV (conditional recommendation, very low certainty); 3) we suggest not initiating long-term NIV during an admission for acute-on-chronic hypercapnic respiratory failure, favoring instead reassessment for NIV at 2–4 weeks after resolution (conditional recommendation, low certainty); 4) we suggest not using an in-laboratory overnight polysomnogram to titrate NIV in patients with chronic stable hypercapnic COPD who are initiating NIV (conditional recommendation, very low certainty); and 5) we suggest NIV with targeted normalization of Pa_CO2 in patients with hypercapnic COPD on long-term NIV (conditional recommendation, low certainty).

Conclusions: This expert panel provides evidence-based recommendations addressing the use of NIV in patients with COPD and chronic stable hypercapnic respiratory failure.

Which Screening Questionnaire is Best for Predicting Obstructive Sleep Apnea in the Sleep Clinic Population Considering Age, Gender, and Comorbidities?

OBJECTIVE

The purpose of this study was to evaluate the predictive power of the screening questionnaires including Epworth Sleepiness Scale (ESS), Berlin questionnaire (BQ) and STOP-Bang questionnaire (SBQ) to identify the high-risk patients for OSA in a sleep clinic setting considering age, gender and comorbidities.

MATERIAL AND METHODS

1003 patients who admitted to our sleep center with the preliminary diagnosis of OSA between June 2016-May 2018 were included in the study. All patients underwent in-lab polysomnographic examination and filled out ESS, Berlin and STOP-Bang questionnaires. Predictive parameters for each screening questionnaires were calculated.

RESULTS

For apnea-hypopnea index (AHI) ≥5/h, the sensitivity and the specificity of the EES, BQ and SBQ were 50.6%, 89.8%, 97.9% and 56.6%, 27.3%, 16.2% respectively. The STOP-Bang questionnaire had the highest sensitivity in both males and females (99.1%, 94.8% respectively) and in the different age groups (97.3% for ≥45 age-group, 99.2% for ≥65 age-group). In the groups of patients with hypertension, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease and asthma, the sensitivity of the STOP-Bang questionnaire was 99.5%, 100%, 99.5%, 100%, 97.4%, respectively.

CONCLUSION

The STOP-Bang questionnaire had the highest sensitivity for detecting high-risk patients for OSA in a sleep clinic setting. STOP-Bang questionnaire was superior to the Berlin questionnaire and ESS in the different groups of age, gender, and comorbidities. Considering the close relationship between OSA and comorbidities, it is critical to screen patients in terms of OSA in outpatient clinics of internal medicine, cardiology, and chest disease departments. The STOP-Bang questionnaire, with its high sensitivity, may be useful for screening OSA. However, the low specificity should be improved in the questionnaire.

Translation and cultural adaptation of the Sleep Apnea Clinical Score for use in Brazil

OBJECTIVE

To translate the Sleep Apnea Clinical Score (SACS) into Brazilian Portuguese and adapt it to the cultural setting, validating it for use as a screening method for polysomnography and as a tool to quantify the risk of obstructive sleep apnea syndrome in individuals in Brazil.

METHODS

The translation was performed by two professionals, with subsequent synthesis of the translations. From that version, a back-translation was prepared, revised, and compared with the original by a team of experts. As a pre-test, a consensus version was applied in 20 patients randomly selected from among those under treatment at outpatient clinics at the Piquet Carneiro Polyclinic of the State University of Rio de Janeiro, in the city of Rio de Janeiro, to assess their understanding of the questions. In the validation phase, the Brazilian-Portuguese version of the SACS was applied in 86 patients who subsequently underwent polysomnography, regardless of the SACS result.

RESULTS

The analyses of the pre-test phase showed that the SACS was easily understood by the patients. In the validation phase, the SACS showed a sensitivity of 45.3% (95% CI: 32.8-58.2%), a specificity of 90.9% (95% CI: 70.8-98.9%), a positive predictive value of 93.5% (95% CI: 79.0-98.2%), a negative predictive value of 36.4% (95% CI: 30.6-42.5%), and an accuracy of 57.0% (95% CI: 45.8-67.6%).

CONCLUSIONS

The Brazilian-Portuguese version of the SACS can be used in order to assess the risk of obstructive sleep apnea syndrome.

Pulmonary Function Influences the Performance of Berlin Questionnaire, Modified Berlin Questionnaire, and STOP-Bang Score for Screening Obstructive Sleep Apnea in Subjects with Chronic Obstructive Pulmonary Disease

Purpose

The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) has been described as the overlap syndrome. The objective of the study is to investigate the performance of Berlin Questionnaire (BQ), modified Berlin Questionnaire (MBQ), and STOP-Bang score in screening overlap syndrome from COPD subjects and investigate how pulmonary function interferes with questionnaire scoring.

Subjects and Methods

Among 116 COPD subjects included in this study, 62 were overlap syndrome subjects and 54 were COPD subjects without OSA. Subjects included were asked to fill out the questionnaires to collect demographic characteristics of subjects and questionnaire scores of BQ, MBQ, and STOP-Bang; perform pulmonary function test to confirm their COPD diagnosis; and perform polysomnography.

Results

AUC (area under the curve) of BQ, MBQ, and STOP-Bang score in screening OSA among patients with COPD was 0.71 (0.64–0.79), 0.75 (0.67–0.83), and 0.72 (0.64–0.80). In COPD subjects without OSA, FEV1%pred was statistically associated with the misdiagnosis of BQ (P= 0.0091), MBQ (P= 0.0143), and STOP-Bang (P= 0.0453). In patients with overlap syndrome, FVC%pred affected the risk of misdiagnosis of the three questionnaires (BQ: P= 0.0413; MBQ: P= 0.0150; STOP-Bang: P= 0.0241). BMI and neck circumferences (NC) were negatively correlated with FEV1%pred (BMI: P= 0.0454; NC: P= 0.0230) and FVC%pred (BMI: P= 0.0042; NC: P= 0.0367) in overlap subjects. In contrast, BMI was positively correlated with FEV1/FVC (P= 0.0141) and FEV1%pred (P= 0.0391) in COPD subjects without OSA.

Conclusion

BQ, MBQ, and STOP-Bang score performed well in COPD subjects for screening OSA. The diagnosis of the three questionnaires was more accurate in subjects with lower FEV1%pred or FVC%pred value. Pulmonary function might exert influence on the diagnosis efficacy of the three questionnaires through BMI and neck circumference.

The Screening Value Of ESS, SACS, BQ, And SBQ On Obstructive Sleep Apnea In Patients With Chronic Obstructive Pulmonary Disease

Objective

To compare the performance of Epworth sleepiness scale (ESS), sleep apnea clinical score (SACS), Berlin questionnaire (BQ), and STOP-BANG questionnaire (SBQ) in screening for obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD).

Methods

A total of 431 patients were analyzed. All subjects completed lung function test, ESS, SACS, BQ, and SBQ survey and overnight polysomnography (PSG). According to lung function and PSG results, participants were divided into COPD with OSA group (OVS, AHI ≥5) and without OSA group (AHI <5). The value of ESS, SACS, BQ, and SBQ was compared in predicting OSA in patients with COPD by receiver-operating characteristic (ROC) curve statistics.

Results

Of the 431 subjects, there were 96 cases in COPD without OSA group, and 335 cases in OVS group including 183, 96, and 56 cases of COPD combined with mild, moderate or severe OSA. In predicting different degrees of severity of OSA in patients with COPD, the value of ESS was poor with all the values of area under the curve (AUC) < 0.7. SACS and BQ had moderate predictive value in screening for severe OSA with the value of AUC of 0.750, 0.735 respectively. However, the SBQ performed best in predicting various degrees of OSA. For screening mild OSA (AHI ≥5), the ROC statistics recommended the cut-off score of SBQ >2 was considered high risk of OSA; the sensitivity, specificity, and AUC were 92.8%, 40.6%, and 0.723 respectively, the odds ratio (OR) was 2.161. When AHI ≥15, AUC for SBQ was 0.737. In predicting severe OSA (AHI ≥30), the ROC curve showed cut-off point, sensitivity, specificity, and AUC for SBQ was >4, 66.1%, 82.1%, and 0.824 respectively; the positive and negative likelihood ratio was 3.70, 0.41 separately, the OR was 2.977.

Conclusion

SBQ performed better than ESS, SACS, and BQ in predicting OSA in patients with COPD.

Sleepless in Beirut: Sleep Difficulties in an Urban Environment With Chronic Psychosocial Stress

STUDY OBJECTIVES

The prevalence of sleep disorders in the Lebanese population is unknown. We assessed the prevalence of insomnia and sleep apnea risk and examined their relationship with sociodemographic, lifestyle, and health characteristics in a sample from Greater Beirut.

METHODS

This cross-sectional pilot survey included 501 adults from the community (age 45.2 ± 15.2 years, 64% females). Insomnia symptoms, insomnia disorder, and sleep apnea risk were assessed using the Sleep Heart Health Study and Berlin Questionnaire. Characteristics were compared between individuals with and without insomnia symptoms, insomnia disorder, and sleep apnea. Correlates were assessed using multivariate regression.

RESULTS

A total of 44.5% of participants reported insomnia symptoms > 15 nights/mo and 34.5% reported insomnia. Predictors of insomnia symptoms and disorder included female sex (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.01-2.27 and OR 1.76, 95% CI 1.13-2.75, respectively), education level below high school (OR 1.96, 95% CI 1.31-2.95 and OR 2.40, 95% CI 1.52-3.77, respectively) and medical comorbidities (OR 2.27, 95% CI 1.30-3.95 and OR 3.02, 95% CI 1.3-5.27, respectively). Although 31% of participants were at high risk for sleep apnea, only 5% received the diagnosis from a physician. Increased sleep apnea risk was associated with unemployment (OR 1.96, 95% CI 1.11-3.49), high body mass index (OR 1.17, 95% CI 1.11-1.24), snoring (OR 16.7, 95% CI 9.0-31.0), hypertension (OR 4.33, 95% CI 2.28-8.22), arthritis (OR 2.00, 95% CI 1.01-4.01), and other medical comorbidities (OR 2.65, 95% CI 1.24-5.68).

CONCLUSIONS

Insomnia and sleep apnea are highly prevalent and likely underdiagnosed in this cohort from Lebanon and are associated with disadvantaged socioeconomic status and medical comorbidities. This alarming prevalence of sleep difficulties and disorders calls for future research exploring the causes including the potential effect of social, economic, and political instability, mental and psychological stress, local customs, and environmental factors.

The triad of obstructive sleep apnea syndrome, COPD, and obesity: sensitivity of sleep scales and respiratory questionnaires

Objective:

To investigate whether the presence of obstructive sleep apnea syndrome (OSAS) alters the perception of respiratory symptoms and quality of life in COPD patients, by using specific questionnaires, as well as to determine whether scales for assessing daytime sleepiness and for screening for OSAS can be used in the triad of OSAS, COPD, and obesity.

Methods:

We included 66 patients diagnosed with mild-to-moderate or severe COPD and presenting with a body mass index > 27 kg/m². After polysomnography, patients completed the Epworth sleepiness scale (ESS), the Berlin questionnaire (BQ), the modified Medical Research Council (mMRC) scale, the Baseline Dyspnea Index (BDI), and the Saint George’s Respiratory Questionnaire (SGRQ).

Results:

Patients were first divided into two groups: COPD + OSAS (n = 46); and COPD-only (n = 20). The COPD + OSAS group was subdivided into a COPD + mild-to-moderate OSAS group (n = 32) and a COPD + severe OSAS group (n = 14), all of which were compared with the COPD-only group. There was a significant difference in mean FEV₁ (L) between the COPD + OSAS groups and the COPD-only group (p = 0.073). The presence of the triad did not lead to significantly higher ESS scores, and scores > 10 had a specificity of 0.58. The BQ did not identify high risk for OSAS in the presence of the triad (specificity of 0.31). There were no significant differences in domain or total scores of the SGRQ between the COPD + OSAS groups and the COPD-only group.

Conclusions:

The confounding factors present in the triad of OSAS, COPD, and obesity prevented the perception of increased daytime sleepiness and high risk for OSAS. We observed no worsening of dyspnea perception or quality of life.

Association between Sleep Disturbances and Liver Status in Obese Subjects with Nonalcoholic Fatty Liver Disease: A Comparison with Healthy Controls

The relevance of sleep patterns in the onset or evolution of nonalcoholic fatty liver disease (NAFLD) is still poorly understood. Our aim was to investigate the association between sleep characteristics and hepatic status indicators in obese people with NAFLD compared to normal weight non-NAFLD controls. Ninety-four overweight or obese patients with NAFLD and 40 non-NAFLD normal weight controls assessed by abdominal ultrasonography were enrolled. Hepatic status evaluation considered liver stiffness determined by Acoustic Radiation Force Impulse elastography (ARFI) and transaminases. Additionally, anthropometric measurements, clinical characteristics, and biochemical profiles were determined. Sleep features were evaluated using the Pittsburgh Sleep Quality Index (PSQI). Hepatic status parameters, anthropometric measurements, and clinical and biochemical markers differed significantly in NAFLD subjects compared to controls, as well as sleep efficiency, sleep disturbance score, and sleep quality score. In the NAFLD group, a higher prevalence of short sleep duration (p = 0.005) and poor sleep quality (p = 0.041) were found. Multivariate-adjusted odds ratio (95% confidence interval) for NAFLD considering sleep disturbance was 1.59 (1.11–2.28). Regression models that included either sleep disturbance or sleep quality predicted up to 20.3% and 20.4% of the variability of liver stiffness, respectively, and after adjusting for potential confounders. Current findings suggest that sleep disruption may be contributing to the pathogenesis of NAFLD as well as the alteration of the liver may be affecting sleep patterns. Consequently, sleep characteristics may be added to the list of modifiable behaviors to consider in health promotion strategies and in the prevention and management of NAFLD.

Prevalence and Predictors of Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease Undergoing Inpatient Pulmonary Rehabilitation

The aim of our study was to evaluate the prevalence and predictors of obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD) undergoing inpatient pulmonary rehabilitation programs (PRPs). A retrospective data review of consecutive stable patients with a known diagnosis of COPD, admitted for PRP between January 2007 and December 2013. Full overnight polysomnography (PSG) and Epworth Sleepiness Scale (ESS) were assessed in all patients. Out of 422 evaluated patients, 190 (45%) showed an Apnea Hypopnea Index (AHI) ≥ 15 events/hour and underwent OSA treatment. Patients with OSA were significantly younger and had a less severe airway obstruction as compared to patients without OSA. There were no significant differences in cardiac comorbidities nor in arterial blood gases. As expected, patients with OSA showed significantly more severe diurnal symptoms, as assessed by the ESS and higher body mass index (BMI). However, only 69 out of 190 patients with OSA (36.3%) showed an ESS >10, whereas 25% of them had BMI ≤25 and 41% of them had a BMI <30. In all, 68% of patients with OSA were discharged with continuous positive airway pressure (CPAP), 15% with Bilevel ventilation, and 17% without any ventilatory treatment. In conclusion, in the population studied, the combination of OSA and COPD was frequent. BMI and ESS values commonly considered cutoff values for the prediction of OSA in the general population may not be accurate in a subgroup of patients with COPD.

Sleepiness, fatigue, anxiety and depression in Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea - Overlap - Syndrome, before and after continuous positive airways pressure therapy

Patients with Chronic Obstructive Pulmonary Disease (COPD) and / or Obstructive Sleep Apnea (OSA) often complain about sleepiness, fatigue, anxiety and depression. However, common screening questionnaires, like Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS) and Hospital Anxiety and Depression Scale (HADS) have not been previous evaluated in patients with overlap-coexisting COPD and OSA-syndrome versus patients with OSA alone. Our study compared ESS, FSS and HADS between patients with overlap syndrome and patients with OSA, before and after treatment with Continuous Positive Airways Pressure (CPAP). We examined 38 patients with coexisting COPD and OSA versus 38 patients with OSA-only and 28 subjects without respiratory disease, serving as controls. All patients underwent pulmonary function tests (PFTs), oximetry and overnight polysomnography and completed the questionnaires, before and after 3 months of CPAP therapy. The two patient groups did not differ significantly in terms of age, Body Mass Index (BMI), neck, waist and hip circumferences, and arterial blood pressure values. They also had similar comorbidities. They differed significantly, as expected, in PFTs (Forced Vital Capacity-FVC, 2.53±0.73 vs 3.08±0.85 lt, p = 0.005, Forced Expiratory Volume in 1sec-FEV1, 1.78±0.53 vs 2.60±0.73 lt/min, p<0.001) and in daytime oximetry (94.75±2.37 vs 96.13±1.56%, p = 0.007). ESS, HADS-Anxiety and HADS-Depression scores did not differ statistically significant between these two groups, whereas overlap syndrome patients expressed significantly more fatigue (FSS) than OSA-only patients, a finding that persisted even after 3 months of CPAP therapy. We conclude that sleepiness, anxiety and depression were similar in both groups, whereas fatigue was more prominent in patients with overlap syndrome than in sleep apneic patients and did not ameliorate after treatment.

Screening Questionnaires for Obstructive Sleep Apnea: An Updated Systematic Review

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is associated with significant morbidity. We sought to present an updated systematic review of the literature on the accuracy of screening questionnaires for OSA against polysomnography (PSG) as the reference test. Using the main databases (including Medline, Cochrane Database of Systematic Reviews and Scopus) we used a combination of relevant keywords to filter studies published between January 2010 and April 2017. Population-based studies evaluating the accuracy of screening questionnaires for OSA against PSG were included in the review. Thirty-nine studies comprising 18 068 subjects were included. Four screening questionnaires for OSA had been validated in selected studies including the Berlin questionnaire (BQ), STOP-Bang Questionnaire (SBQ), STOP Questionnaire (SQ), and Epworth Sleepiness Scale (ESS). The sensitivity of SBQ in detecting mild (apnea-hypopnea index (AHI) ≥ 5 events/hour) and severe (AHI ≥ 30 events/hour) OSA was higher compared to other screening questionnaires (range from 81.08% to 97.55% and 69.2% to 98.7%, respectively). However, SQ had the highest sensitivity in predicting moderate OSA (AHI ≥ 15 events/hour; range = 41.3% to 100%). SQ and SBQ are reliable tools for screening OSA among sleep clinic patients. Although further validation studies on the screening abilities of these questionnaires on general populations are required.

The National Healthy Sleep Awareness Project Sleep Health Surveillance Questionnaire as an Obstructive Sleep Apnea Surveillance Tool

STUDY OBJECTIVES

To validate the previously published National Healthy Sleep Awareness Project (NHSAP) Surveillance and Epidemiology Workgroup questionnaire for ability to determine risk for moderate to severe obstructive sleep apnea (OSA).

METHODS

The NHSAP sleep questions, part of the next Behavioral Risk Factor Surveillance System (BRFSS), were constructed to mimic elements of the STOP sleep apnea questionnaire, and included number of days with sleep disruption and unintentional dozing and a history of snoring and apneas. The responses to four sleep questions from the BRFSS were collected from 352 adults undergoing in-laboratory polysomnography at Mayo Clinic, Rochester, Minnesota. Demographic and clinical information, including sex, age, body mass index (BMI), and presence of hypertension, which will be available in other parts of the complete BRFSS, were obtained by chart review. Univariate and logistic regression analyses were performed, and values of P < .05 were considered to be statistically significant.

RESULTS

Fifty-five percent of subjects were men and 45% were women with a median age of 58 years and BMI 32.2 kg/m². Sixty percent had no or mild OSA, and 40% had moderate to severe OSA. No single question was superior in screening for moderate to severe OSA, although a history of snoring and witnessed apneas was more likely to predict moderate to severe OSA. Male sex, age ≥ 50 years, BMI ≥ 30 kg/m², presence of hypertension, and a history of snoring and witnessed apneas were the most highly weighted factors in predicting moderate to severe OSA. When each variable was dichotomized to a single point, a cutoff of 5 points significantly predicted a high risk of moderate to severe OSA with an odds ratio of 3.87 (2.39-6.27).

CONCLUSIONS

Although many variables were positively associated with the apnea-hypopnea index, no single factor was superior in predicting moderate to severe OSA. Male sex, increased age, higher BMI, hypertension, and a history of snoring and witnessed apneas are the most highly predictive of moderate to severe OSA. Combined use of the NHSAP questionnaire and demographic and clinical characteristics could be considered for screening for moderate to severe OSA.

Observation and Interview-based Diurnal Sleepiness Inventory for measurement of sleepiness in older adults

INTRODUCTION

There is no established reference standard for subjective measures of sleepiness in older adults.

METHODS

This study compares the Observation and Interview-based Diurnal Sleepiness Inventory (ODSI) with two existing instruments for measurement of sleepiness and daily functioning, the Epworth Sleepiness Scale (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ).

RESULTS

A total of 125 study participants were included in this study and were administered the ODSI, ESS and FOSQ; subjects had a mean age of 70.9 ± 5.27 years, mean Apnea-Hypopnea Index of 31.9 ± 27.9 events/hour and normal cognitive functioning (Mini-Mental State Examination score > 24). The ODSI showed a significant association with the ESS (Spearman's ρ: 0.67, P < 0.001) and with the FOSQ (Spearman's ρ: -0.52, P < 0.001). The ODSI 1 item (assessing sleepiness in active situations) was borderline significantly correlated with the ESS (β = 0.14; 95% confidence interval [CI], -0.01 to 0.29; P = 0.069). ODSI 2 item (sleepiness in passive situations) was correlated with the ESS (β = 1.65; 95% CI, 1.32 to 1.98; P < 0.001). Both ODSI 1 (β = -0.15; 95% CI, -0.24 to -0.07; P < 0.001) and ODSI 2 (β = -0.35; 95% CI, -0.55 to 0.16; P < 0.001) were significantly correlated with the FOSQ.

CONCLUSION

The ODSI is a suitable measure of sleepiness and is appropriate for usage in clinical care in older adults.