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CC BY-NC-ND 4.0 · Sleep Sci 2022; 15(S 01): 203-208
DOI: 10.5935/1984-0063.20220020
ORIGINAL ARTICLES

Screening for obstructive sleep apnea in elderly: performance of the Berlin and STOP-Bang questionnaires and the Epworth Sleepiness Scale using polysomnography as gold standard

Authors

  • Paulo Henrique Godoy

    1   Federal University of the State of Rio de Janeiro, Sleep Laboratory of the Federal University of the State of Rio de Janeiro - LABSONO UNIRIO - Rio de Janeiro - Rio de Janeiro - Brazil.

  • Ana Paula Cassetta dos Santos Nucera

    1   Federal University of the State of Rio de Janeiro, Sleep Laboratory of the Federal University of the State of Rio de Janeiro - LABSONO UNIRIO - Rio de Janeiro - Rio de Janeiro - Brazil.

  • Andressa de Paiva Colcher

    1   Federal University of the State of Rio de Janeiro, Sleep Laboratory of the Federal University of the State of Rio de Janeiro - LABSONO UNIRIO - Rio de Janeiro - Rio de Janeiro - Brazil.

  • Jéssica Escorcio de-Andrade

    1   Federal University of the State of Rio de Janeiro, Sleep Laboratory of the Federal University of the State of Rio de Janeiro - LABSONO UNIRIO - Rio de Janeiro - Rio de Janeiro - Brazil.

  • Davi da Silveira Barroso Alves

    2   Federal University of the State of Rio de Janeiro, Department of Quantitative Methods of the Federal University of the State of Rio de Janeiro - Rio de Janeiro - Rio de Janeiro - Brazil.
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Objectives Obstructive sleep apnea (OSA) affects approximately one third of the population and can reach 90% prevalence in the elderly. There are screening tools to track the disease, however, their performance may differ according to population characteristics. This study aims to determine sensitivity, specificity, predictive value, likelihood ratio and accuracy of the Berlin (BQ) and STOP-Bang (S-Bang) questionnaires and the Epworth Sleepiness Scale (ESS), comparing their performances, using polysomnography (PSG) as a gold standard, in a sample of elderly.

Methods The study was cross-sectional, retrospective, included patients aged 60 or older who underwent PSG type 1, regardless of the BQ, S-Bang and ESS results, during the period of June 1, 2017 to April 30, 2019. OSA diagnosis was by PSG in which the hypopnea apnea index was greater than or equal to 5.

Results Sixty- two patients were evaluated; the prevalence of OSA was 72.58%. The mean age in the sample with OSA was 73.0 sd 8.4 years and without it was 74.7 sd 8.1 years. The sample was predominantly female, 58.1% with OSA. The BQ showed the best results for specificity, predictive value, likelihood ratio and accuracy. S-Bang had the best result for sensitivity and ESS showed the worst results. The BQ odds ratio showed that an individual with a positive BQ has 335% more chance of developing OSA.

Conclusion The QB showed the best performance in the measures for identifying OSA, for a sample of elderly individuals, with a predominance of females and a high prevalence of the disease.

Sleep Apnea - Obstructive - Mass Screening - Surveys and Questionnaires - Aged


Publication History

Received: 05 July 2021

Accepted: 05 October 2021

Article published online:
01 December 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Thurnheer R. Diagnostic approach to sleep-disordered breathing. Expert Review of Respiratory Medicine. 2011;5(4):573-589.
  • 2 Abbasi A, Gupta SS, Sabharwall N, Meghrajanil V, Shaurya Sharma S, Kamholzl S, et al. A comprehensive review of obstructive sleep apnea. Sleep Sci. 2021;14(2):142-154.
  • 3 Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Medicine Reviews. 2016;34:70-81.
  • 4 Tufik S, Santos-Silva R, Taddei JA, Bittencourt LRA. Obstructive Sleep Apnea Syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441-6.
  • 5 Iannella G, Magliulo G, Lo Iacono C, Bianchi G, Polimeni A, Greco A, et al. Positional Obstructive Sleep Apnea Syndrome in Elderly Patients. International Journal of Environmental Research and Public Health. 2020;17:1120.
  • 6 Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire: A practical approach to screen for obstructive sleep apnea. Chest. 2016;149(3):631.8.
  • 7 Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: Pathophysiology and diagnosis. Chest. 2007;132(1):325.37.
  • 8 de Moura WL, de Moura CS, Silva TS de O, Sipau.ba GMO, de Moura MSL, Martins GAS. Prevale.ncia do risco da Si.ndrome da Apneia Obstrutiva do Sono na populac.a.o adulta de uma capital brasileira. Revista Da Faculdade De Odontologia- UPF. 2018;22(3):303.8.
  • 9 Viegas CAA. Epidemiology of sleep-disordered breathing [Abstract]. J Bras Pneumol. 2010;36(SUPPL. 2):1.3.
  • 10 Senaratna CV, Perret JL, Matheson MC, Lodge CJ, Lowe AJ, Cassim R, et al. Validity of the Berlin questionnaire in detecting obstructive sleep apnea: A systematic review and meta- analysis. Sleep Medicine Reviews. 2017;36:116.24.
  • 11 Shahid A, Wilkinson K, Marcu S, Shapiro CM. STOP, THAT and One Hundred Other Sleep Scales. In: Shahid A, Wilkinson K, Marcu S, Shapiro CM, editors. New York: Springer-Verlag; 2012. P. 1-406.
  • 12 Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485-91.
  • 13 Zancanella E, Haddad FM, Oliveira LAMP, Nakasato A, Duarte BB, Soares CFP, et al. Apneia obstrutiva do sono e ronco prima.rio: diagno.stico. Braz J Otorhinolaryngol. 2014;80(1 SUPPL. 1):1-16.
  • 14 Arau.jo-Melo MH, Neves DD, Ferreira LVMV, Moreira MLV, Nigri R, Simo.es SMG. Questiona.rios e Escalas u.teis na pesquisa da Si.ndrome da Apneia Obstrutiva do Sono. Rev Hosp Univ Pedro Ernesto . 2016;15(1):48-54.
  • 15 Vaz AP, Drummond M, Mota PC, Severo M, Almeida J, Winck JC. Traduc.a.o do Questiona.rio de Berlim para li.ngua Portuguesa e sua aplicac.a.o na identificac.a.o da SAOS numa consulta de patologia respirato.ria do sono. Rev Port Pneumol. 2011;17(2):59-65.
  • 16 Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: A tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812.21.
  • 17 The Official STOP-Bang Questionnaire Website. Toronto: Toronto Western Hospital, University Health Network. University of Toronto [Internet]. [updated 2021 May 2; cited 2021 May 25]. Available from: http://www.stopbang.ca/
  • 18 Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep. 1991;14(6):540-5.
  • 19 Guimara.es C, Martins MV, Vaz Rodrigues L, Teixeira F, Moutinho dos Santos J. Escala de sonole.ncia de Epworth na si.ndrome de apneia obstrutiva do sono: Uma subjetividade subestimada. Rev Port Pneumol. 2012;18(6):267-71.
  • 20 Johns MW. Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: Failure of the MSLT as a gold standard. J Sleep Res. 2000;9(1):5-11.
  • 21 Nogueira C, Oliveira Azevedo I, Bentes P, Magalhaes A, Andrade Lacerda C, Vera M, et al. The Effectiveness of the Epworth Sleepiness Scale as an Auxiliary Resource in the Diagnosis of Obstructive Sleep Apnea Syndrome. Rev Bras em Promoc.a.o da Sau.de. 2013;26(1):56-62.
  • 22 Musman S, de Azeredo Passos VM, Silva IBR, Barreto SM. Avaliac.a.o de um modelo de predic.a.o para apneia do sono em pacientes submetidos a polissonografia. J Bras Pneumol. 2011;37(1):75.84.
  • 23 Kuna ST, Badr MS, Kimoff RJ, Kushida C, Lee-Chiong T, Levy P, et al. ATS/AASM/ACCP/ERS Committee on Ambulatory Management of Adults with OSA. An official ATS/AASM/ACCP/ERS workshop report: Research priorities in ambulatory management of adults with obstructive sleep apnea. Proc Am Thorac Soc. 2011;8(1):1-16.
  • 24 Haddad,F.; Bittencourt, L. Recomendac.o.es para o diagno.stico e tratamento da si.ndrome da apneia obstrutiva do sono no adulto [Diretrizes]. Sa.o Paulo: Estac.a.o Brasil; 2013.
  • 25 R Core Team [Internet]. Vienna, Austria: R: A language and environment for statistical computing. R Foundation for Statistical Computing. [updated 2019 June 1; cited 2021 May 26]. Available from: https://www.R-project.org/
  • 26 Ferreira JC, Patino CM. Understanding diagnostic tests. Part 3. J Bras Pneumol. 2018;44(1):4.
  • 27 de Oliveira GM, Camargo FT, Gon.alves EC, Duarte CVN, Guimaraes CA. Systematic review of diagnostic tests accuracy: A narrative review. Rev Col Bras Cir. 2010;37(2):153.6.
  • 28 Stelmach-Mardas M, Iqbal K, Mardas M, Kostrzewska M, Piorunek T. Clinical utility of Berlin questionnaire in comparison to polysomnography in patients with obstructive sleep apnea. Adv Exp Med Biol. 2017;980:51-57.
  • 29 Miller JN, Kupzyk KA, Zimmerman L, Pozehl B, Schulz P, Romberger D, et al. Comparisons of measures used to screen for obstructive sleep apnea in patients referred to a sleep clinic. Sleep Med. 2018;51:15-21.
  • 30 Fonseca LB de M, Silveira EA, Lima NM, Rabahi MF. STOP-Bang questionnaire: Translation to Portuguese and cross-cultural adaptation for use in Brazil. J Bras Pneumol. 2016;42(4):266.72.
  • 31 Duarte RL de M, Fonseca LB de M, Magalha.es-Da-Silveira FJ, Da Silveira EA, Rabahi MF. Validac.a.o do questiona.rio STOP-Bang para a identificac.a.o de apneia obstrutiva do sono em adultos no Brasil. J Bras Pneumol. 2017;43(6):456.63.
  • 32 Ferreira JC, Patino CM. Understanding diagnostic tests. Part 1. J Bras Pneumol. 2017;43(5):330.
  • 33 Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, Wang YC, Guilleminault C. Diagnostic accuracy of the Berlin questionnaire, STOPBANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis. Sleep Med Rev. 2017;36:57-70.
  • 34 Martins EF, Martinez D, Cortes AL, Nascimento N, Brendler J. Exploring the STOP-BANG questionnaire for obstructive sleep apnea screening in seniors. J Clin Sleep Med. 2020;16(2):199-206.
  • 35 Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Barreto SSM, Johns MW. Portuguese- language version of the Epworth sleepiness scale: Validation for use in Brazil. J Bras Pneumol. 2009;35(9):877.83.
  • 36 Pen.afiel FS, Poniachik JG, Lo.pez AC, Monasterio JU, Patin.o OD. Accuracy of sleep questionnaires for obstructive sleep apnea syndrome screening. Rev Med Chil. 2018;146(10):1123.34.
  • 37 Senaratna CV, Perret JL, Lowe A, Bowatte G, Abramson MJ, Thompson B, et al. Detecting sleep apnea syndrome in primary care with screening questionnaires and the Epworth sleepiness scale. Med J Aust. 2019;211(2):65.70.
  • 38 Sforza E, Chouchou F, Collet P, Pichot V, Barthe, J C; Roche F. Sex differences in obstructive sleep apnoea in an elderly French population. Eur Respir J. 2011;37(5):1137-43