Abstract:
Objective: To examine the utility of apnoea screening
questionnaires, alone and in combination with the Epworth
sleepiness scale (ESS), for detecting obstructive sleep apnoea (OSA)
in primary care.
Design, setting: Prospective validation study in an Australian
general population cohort.
Participants: 424 of 772 randomly invited Tasmanian Longitudinal
Health Study, 6th decade follow-up participants with OSA
symptoms (mean age, 52.9 years; SD, 0.9 year) who completed OSA
screening questionnaires and underwent type 4 sleep studies.
Main outcome measures: Clinically relevant OSA, defined as
moderate to severe OSA (15 or more oxygen desaturation events/
hour), or mild OSA (5–14 events/hour) and excessive daytime
sleepiness (ESS ≥ 8); diagnostic test properties of the Berlin (BQ),
STOP-Bang and OSA-50 questionnaires, alone or combined with an
ESS ≥ 8.
Results: STOP-Bang and OSA-50 correctly identified most
participants with clinically relevant OSA (sensitivity, 81% and 86%
respectively), but with poor specificity (36% and 21% respectively);
the specificity (59%) and sensitivity of the BQ (65%) were both low.
When combined with the criterion ESS ≥ 8, the specificity of each
questionnaire was high (94–96%), but sensitivity was low (36–
51%). Sensitivity and specificity could be adjusted according to
specific needs by varying the STOP-Bang cut-off score when
combined with the ESS ≥ 8 criterion.
Conclusions: For people likely to trigger OSA assessment in
primary care, the STOP-Bang, BQ, and OSA-50 questionnaires,
combined with the ESS, can be used to rule in, but not to rule out
clinically relevant OSA. Combined use of the STOP-Bang with
different cut-off scores and the ESS facilitates a flexible balance
between sensitivity and specificity
