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Diagnostic value of berlin questionnaire as a screening tool for obstructive sleep apnea-hypopnea syndrome
Abstracts / Sleep Medicine 14S (2013) e165–e238
energy intake to energy expenditure (EI-to-TEE ratio). In this study, lower EI-to-TEE ratio reflects underreport of energy intake. Sleep disturbance was assessed with the Pittsburgh Sleep Quality Index, and its score P6 was defined as sleep disturbance. The logistic regression model was used to assess the association between disturbance and overweight, and effects of modification by EI, EE and EI-to-TEE ratio. Results: The sleep disturbance was associated with higher risk of being overweight. The multivariable odds ratio and 95% confidence intervals for the subjects with sleep disturbance compared to those without sleep disturbance was 1.44 (1.17–1.78). The effect modification by ratio of EI-to-TEE ratio to above association was statistically significant (p for interaction = 0.03), while those by EI and EE were not significant. After stratification by median-value of EI-to-TEE ratio, there was a significant association between sleep disturbance and being overweight among lower group, but not among higher group. Conclusion: We found a significant effect modification by underreport of energy intake to the association between sleep disturbance and being overweight. Further research is needed to clarify the mechanism of this modification. Acknowledgements: We are grateful to the participants of the Toon health study, and those who supported for this study. http://dx.doi.org/10.1016/j.sleep.2013.11.476
Effectiveness of home single-channel nasal pressure for sleep apnea diagnosis J. Masa Servicio Extremeño de Salud (SES), Hospital San Pedro de Alcántara, Neumología, Spain
Introduction: Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis but no cost studies have been carried out. Automatic scoring is simpler but less effective than manual scoring. However, there have been no studies comparing the efficacy and cost of PSG with HNP with manual scoring, automatic scoring or sequential protocol (automatic and then manual scoring for undiagnosed subjects). Objectives: To determine the diagnostic efficacy and cost of two HNP protocols, manual and sequential, compared with in-hospital PSG. Materials and methods: We included suspected OSA patients in a multicentric study. They were assigned to home and hospital protocols at random. We constructed Receiver Operating Characteristic (ROC) curves for manual and automatic scorings. Diagnostic efficacy was explored for several HNP apnea-hypopnea index cut-off points and costs were calculated for equally effective alternatives. Results: Of 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic scoring. 67% of the patients who underwent HNP were correctly classified (OSA or not) with manual scoring, as were 61% with sequential protocol. The costs of PSG were more than double those of the manual HNP and sequential HNP protocols, with minimal differences between them. Conclusion: HNP is a significantly cheaper alternative for diagnosis in patients with suspected OSA. The costs of the sequential protocol (automatic scoring and then manual scoring for invalid automatic recording) were lower than automatic scoring and similar to manual scoring, for the same diagnostic efficacy as PSG. Acknowledgements: Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias, Ministerio de Sanidad y Consumo) PI050402, Spanish Respiratory Foundation 2005 (FEPAR) and Departamento de Sanidad del Gobierno Vasco (2005111010) and Caja Vital (2005).
e201
http://dx.doi.org/10.1016/j.sleep.2013.11.477
Diagnostic value of berlin questionnaire as a screening tool for obstructive sleep apnea-hypopnea syndrome A. Matevosyan 1, G. Podosyan 2, G. Khandanyan 3, A. Shukuryan 3, P. Zelveian 2 1 Sleep Research Laboratory at the Center of Preventive Cardiology, Yerevan, MD, Armenia 2 Center of Preventive Cardiology, National Institute of Health, Member of ESC, Yerevan, Armenia 3 Yerevan State Medical University, Yerevan, Armenia
Introduction: The aim of our study was to estimate the diagnostic value of Berlin Questionnaire (BQ) for screening obstructive sleep apnea- hypopnea syndrome (OSAHS). Materials and methods: One hundred fifty-five OSAS suspected patients were referred to ‘‘Sleep Research Laboratory’’ at the ‘‘Center of Preventive Cardiology’’. They were all screened by translated BQ and subsequently underwent full polysomnographic (PSG) examination. All PSG were done using ‘‘Embla N7000’’ and ‘‘Somnologica Studio 4.0’’ software. The statistical analysis was performed by CIA 2.2.0 software. Results: From the studied sample, 138 (89.0%) were males, with a mean age of 44.8 12.0 years, body mass index – 34.6 6.3 kg/m2. Each category from three sections of BQ was estimated separately. Categories 1, 2 and 3 were positive in 92.3%, 56.8% and 85.8%, respectively. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of BQ was calculated considering an apneahypopnea index (AHI) P5/h as cutoff criteria for OSAHS, assessed by PSG. BQ sensitivity and specificity were 93.4 (95% CI 87.9– 96.5%) and 52.6% (95% CI 31.7–72.7%). PPV and NPV were 93.4% (95% CI 87.9–96.5%) and 52.6% (95% CI 31.7–72.7%), respectively. Conclusion: In our sample the BQ provides a high level sensitivity and moderate specificity for OSAHS diagnosis. Thus, BQ is a useful tool for screening, but it has a limited value for OSAHS diagnosis. Acknowledgements: Anna Petrosyan laboratory technician. http://dx.doi.org/10.1016/j.sleep.2013.11.478
Mandible behavior during wakefulness and sleep-disordered breathing: intra- and inter-scorer variability for the visual recognition of the mandible movement isolated G. Maury 1, F. Senny 2, C. Laurent 3, A. Albert 4, S. Laurence 4, P. Robert 3 1 Service de Pneumologie, Université catholique de Louvain, CHU Mont Godinne Dinant, Belgium 2 Montefiore Department for Microsystems and HELMO Gramme, University of Liège, Belgium 3 Sleep/Wake Center of the University Hospital of Liège, University of Liège, Belgium 4 Medical Informatics and Biostatistics, University of Liège, Belgium
Introduction: Mandible movement (MM) study has been recently used in an automated analysis in a screening portable device for sleep apnea. This signal provides information on the mandible activity. It could be read visually to assess sleep/wake state and respiratory events. The aims were (1) to evaluate the possibility to teach 4 independent raters to recognize the signal specificities in seven conditions; (2) to assess the intra-scorer reproducibility and (3) the inter-scorer variability.
energy intake to energy expenditure (EI-to-TEE ratio). In this study, lower EI-to-TEE ratio reflects underreport of energy intake. Sleep disturbance was assessed with the Pittsburgh Sleep Quality Index, and its score P6 was defined as sleep disturbance. The logistic regression model was used to assess the association between disturbance and overweight, and effects of modification by EI, EE and EI-to-TEE ratio. Results: The sleep disturbance was associated with higher risk of being overweight. The multivariable odds ratio and 95% confidence intervals for the subjects with sleep disturbance compared to those without sleep disturbance was 1.44 (1.17–1.78). The effect modification by ratio of EI-to-TEE ratio to above association was statistically significant (p for interaction = 0.03), while those by EI and EE were not significant. After stratification by median-value of EI-to-TEE ratio, there was a significant association between sleep disturbance and being overweight among lower group, but not among higher group. Conclusion: We found a significant effect modification by underreport of energy intake to the association between sleep disturbance and being overweight. Further research is needed to clarify the mechanism of this modification. Acknowledgements: We are grateful to the participants of the Toon health study, and those who supported for this study. http://dx.doi.org/10.1016/j.sleep.2013.11.476
Effectiveness of home single-channel nasal pressure for sleep apnea diagnosis J. Masa Servicio Extremeño de Salud (SES), Hospital San Pedro de Alcántara, Neumología, Spain
Introduction: Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis but no cost studies have been carried out. Automatic scoring is simpler but less effective than manual scoring. However, there have been no studies comparing the efficacy and cost of PSG with HNP with manual scoring, automatic scoring or sequential protocol (automatic and then manual scoring for undiagnosed subjects). Objectives: To determine the diagnostic efficacy and cost of two HNP protocols, manual and sequential, compared with in-hospital PSG. Materials and methods: We included suspected OSA patients in a multicentric study. They were assigned to home and hospital protocols at random. We constructed Receiver Operating Characteristic (ROC) curves for manual and automatic scorings. Diagnostic efficacy was explored for several HNP apnea-hypopnea index cut-off points and costs were calculated for equally effective alternatives. Results: Of 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic scoring. 67% of the patients who underwent HNP were correctly classified (OSA or not) with manual scoring, as were 61% with sequential protocol. The costs of PSG were more than double those of the manual HNP and sequential HNP protocols, with minimal differences between them. Conclusion: HNP is a significantly cheaper alternative for diagnosis in patients with suspected OSA. The costs of the sequential protocol (automatic scoring and then manual scoring for invalid automatic recording) were lower than automatic scoring and similar to manual scoring, for the same diagnostic efficacy as PSG. Acknowledgements: Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias, Ministerio de Sanidad y Consumo) PI050402, Spanish Respiratory Foundation 2005 (FEPAR) and Departamento de Sanidad del Gobierno Vasco (2005111010) and Caja Vital (2005).
e201
http://dx.doi.org/10.1016/j.sleep.2013.11.477
Diagnostic value of berlin questionnaire as a screening tool for obstructive sleep apnea-hypopnea syndrome A. Matevosyan 1, G. Podosyan 2, G. Khandanyan 3, A. Shukuryan 3, P. Zelveian 2 1 Sleep Research Laboratory at the Center of Preventive Cardiology, Yerevan, MD, Armenia 2 Center of Preventive Cardiology, National Institute of Health, Member of ESC, Yerevan, Armenia 3 Yerevan State Medical University, Yerevan, Armenia
Introduction: The aim of our study was to estimate the diagnostic value of Berlin Questionnaire (BQ) for screening obstructive sleep apnea- hypopnea syndrome (OSAHS). Materials and methods: One hundred fifty-five OSAS suspected patients were referred to ‘‘Sleep Research Laboratory’’ at the ‘‘Center of Preventive Cardiology’’. They were all screened by translated BQ and subsequently underwent full polysomnographic (PSG) examination. All PSG were done using ‘‘Embla N7000’’ and ‘‘Somnologica Studio 4.0’’ software. The statistical analysis was performed by CIA 2.2.0 software. Results: From the studied sample, 138 (89.0%) were males, with a mean age of 44.8 12.0 years, body mass index – 34.6 6.3 kg/m2. Each category from three sections of BQ was estimated separately. Categories 1, 2 and 3 were positive in 92.3%, 56.8% and 85.8%, respectively. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of BQ was calculated considering an apneahypopnea index (AHI) P5/h as cutoff criteria for OSAHS, assessed by PSG. BQ sensitivity and specificity were 93.4 (95% CI 87.9– 96.5%) and 52.6% (95% CI 31.7–72.7%). PPV and NPV were 93.4% (95% CI 87.9–96.5%) and 52.6% (95% CI 31.7–72.7%), respectively. Conclusion: In our sample the BQ provides a high level sensitivity and moderate specificity for OSAHS diagnosis. Thus, BQ is a useful tool for screening, but it has a limited value for OSAHS diagnosis. Acknowledgements: Anna Petrosyan laboratory technician. http://dx.doi.org/10.1016/j.sleep.2013.11.478
Mandible behavior during wakefulness and sleep-disordered breathing: intra- and inter-scorer variability for the visual recognition of the mandible movement isolated G. Maury 1, F. Senny 2, C. Laurent 3, A. Albert 4, S. Laurence 4, P. Robert 3 1 Service de Pneumologie, Université catholique de Louvain, CHU Mont Godinne Dinant, Belgium 2 Montefiore Department for Microsystems and HELMO Gramme, University of Liège, Belgium 3 Sleep/Wake Center of the University Hospital of Liège, University of Liège, Belgium 4 Medical Informatics and Biostatistics, University of Liège, Belgium
Introduction: Mandible movement (MM) study has been recently used in an automated analysis in a screening portable device for sleep apnea. This signal provides information on the mandible activity. It could be read visually to assess sleep/wake state and respiratory events. The aims were (1) to evaluate the possibility to teach 4 independent raters to recognize the signal specificities in seven conditions; (2) to assess the intra-scorer reproducibility and (3) the inter-scorer variability.