Simulated intention-to-treat analysis based on clinical parameters of patients at high risk for sleep apnea derivated to respiratory polygraphy

Eduardo Enrique Borsini; Magali Blanco; Glenda Ernst; Paulina Montenegro; Alejandro Salvado; Carlos Nigro

doi:10.5935/1984-0063.20180030

Sleep Science, Table of Contents

CC BY-NC-ND 4.0 · Sleep Sci 2018; 11(03): 160-165
DOI: 10.5935/1984-0063.20180030

ORIGINAL ARTICLE

Simulated intention-to-treat analysis based on clinical parameters of patients at high risk for sleep apnea derivated to respiratory polygraphy

Authors

Eduardo Enrique Borsini

¹Hospital Británico de Buenos Aires, Sleep Units - Buenos Aires City - Buenos Aires - Argentina.
Magali Blanco

¹Hospital Británico de Buenos Aires, Sleep Units - Buenos Aires City - Buenos Aires - Argentina.
Glenda Ernst

²Hospital Británico de Buenos Aires, Center for Respiratory Medicine - Buenos Aires City - Buenos Aires - Argentina.
Paulina Montenegro

²Hospital Británico de Buenos Aires, Center for Respiratory Medicine - Buenos Aires City - Buenos Aires - Argentina.
Alejandro Salvado

²Hospital Británico de Buenos Aires, Center for Respiratory Medicine - Buenos Aires City - Buenos Aires - Argentina.
Carlos Nigro

³Hospital Alemán, Sleep Units - Buenos Aires City - Buenos Aires - Argentina.

Abstract

Purpose Obstructive Sleep Apnea-Hypopnea Syndrome (OSAS) is a public health problem. We designed a pilot study to validate empiric indication of CPAP therapy in a population with moderate-to-high pre-test probabilities who underwent self-administered home-based respiratory polygraphy (RP).

Methods A cross-sectional simulation study was performed. CPAP therapy could be indicated by two independent blind observers. Observer 1´s decision was based on the results of STOP-BANG (SBQ) and Epworth Sleepiness Scale (ESS) and Observer 2 used all objective data provided by RP + SBQ + ESS.

Results We evaluated 1763 patients; 1060 men and 703 women (39.2%) with a mean age of 53.6±13.8 and a body mass index (BMI) of 32.8±7.5 kg/m2. We found evidence of mild (34.1%), moderate (26.6%), and severe (18.3%) There were Apnea-Hypopnea Index (AHI) relationship between > 5 or < 5 SBQ and RP AHI (p<0.05). BMI > 25 kg/m² + snoring (S) + observed apnea (O) + 1 of the following: ESS > 11, hypertension (HT) or > 5 SBQ components showed sensitivity of 40% (CI95%:37.3-43) and specificity of 95.1% (CI93.4-96.4). The performance of 5 SBQ components with regard to gender and empirical CPAP therapy was; (women vs. men): AUC-ROC 0.625 (CI95%: 0.599-0.651) vs. 0.70 (CI95%:0.68-0.72), p<0.01, respectively.

Conclusions STOP-BANG and ESS made it possible to indicate CPAP reliably (low rate of false-positive results) in 20-40% of patients who needed such therapy according to clinical history and RP results. These clinical criteria performed better in male.

Sleep Apnea Syndromes - Continuous Positive Airway Pressure - Decision Making

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References

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