Screening for obstructive sleep apnea among hospital outpatients

PLoS One. 2018 May 30;13(5):e0198315. doi: 10.1371/journal.pone.0198315. eCollection 2018.

Abstract

Background: Obstructive sleep apnea syndrome (OSAS) is common in adults. People with OSAS have a higher risk of experiencing traffic accidents and occupational injuries (OIs). We aimed to clarify the diagnostic performance of a three-channel screening device (ApneaLinkTM) compared with the gold standard of full-night attended polysomnography (PSG) among hospital outpatients not referred for sleep-related symptoms. Furthermore, we aimed to determine whether manual revision of the ApneaLinkTM autoscore enhanced diagnostic performance.

Methods: We investigated 68 patients with OI and 44 without OI recruited from the University Hospital Basel emergency room, using a cross-sectional study design. Participating patients spent one night at home with ApneaLinkTM and within 2 weeks slept for one night at the sleep laboratory. We reanalyzed all ApneaLinkTM data after manual revision.

Results: We identified significant correlations between the ApneaLinkTM apnea-hypopnea index (AHI) autoscore and the AHI derived by PSG (r = 0.525; p <0.001) and between the ApneaLinkTM oxygen desaturation index (ODI) autoscore and that derived by PSG (r = 0.722; p <0.001). The ApneaLinkTM autoscore showed a sensitivity and specificity of 82% when comparing AHI ≥5 with the cutoff for AHI and/or ODI ≥15 from PSG. In Bland Altman plots the mean difference between ApneaLinkTM AHI autoscore and PSG was 2.75 with SD ± 8.80 (β = 0.034), and between ApneaLinkTM AHI revised score and PSG -1.50 with SD ± 9.28 (β = 0.060).

Conclusions: The ApneaLinkTM autoscore demonstrated good sensitivity and specificity compared with the gold standard (full-night attended PSG). However, Bland Altman plots revealed substantial fluctuations between PSG and ApneaLinkTM AHI autoscore respectively manually revised score. This spread for the AHI from a clinical perspective is large, and therefore the results have to be interpreted with caution. Furthermore, our findings suggest that there is no clinical benefit in manually revising the ApneaLinkTM autoscore.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Hospitals*
  • Humans
  • Male
  • Mass Screening / instrumentation
  • Mass Screening / methods*
  • Outpatients / statistics & numerical data*
  • Polysomnography
  • Predictive Value of Tests
  • Sleep Apnea, Obstructive / diagnosis*

Grants and funding

This study was financially supported by an unrestricted grant of the Swiss National Accident Insurance Fund (SUVA). Grant number: not applicable. URL: http://www.suva.ch. Recipient: DM. The funder (SUVA) provided support in the form of a project grant that covered salaries for the involved personnel at the University Hospital Basel as well as expenses for infrastructure and conducting the study. However the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The participation of DM in the study was independent from the project grant and is covered by the contractual agreement between SUVA and DM that permits active participation in independently conducted research projects.