Application of Neck Circumference in Four-Variable Screening Tool for Early Prediction of Obstructive Sleep Apnea in Acute Ischemic Stroke Patients

Lisan Zhang; Tingting Zeng; Yaxing Gui; Yi Sun; Fei Xie; Dan Zhang; Xingyue Hu

doi:10.1016/j.jstrokecerebrovasdis.2019.06.011

Application of Neck Circumference in Four-Variable Screening Tool for Early Prediction of Obstructive Sleep Apnea in Acute Ischemic Stroke Patients

J Stroke Cerebrovasc Dis. 2019 Sep;28(9):2517-2524. doi: 10.1016/j.jstrokecerebrovasdis.2019.06.011. Epub 2019 Jul 9.

Authors

Lisan Zhang¹, Tingting Zeng², Yaxing Gui³, Yi Sun³, Fei Xie³, Dan Zhang³, Xingyue Hu³

Affiliations

¹ Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine of Zhejiang University, Hangzhou, Zhejiang, China; Center for Sleep Sciences and Medicine, Sir Run Run Shaw Hospital, School of Medicine of Zhejiang University, Hangzhou, Zhejiang, China. Electronic address: zls09@zju.edu.cn.
² Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine of Zhejiang University, Hangzhou, Zhejiang, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China.
³ Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine of Zhejiang University, Hangzhou, Zhejiang, China; Center for Sleep Sciences and Medicine, Sir Run Run Shaw Hospital, School of Medicine of Zhejiang University, Hangzhou, Zhejiang, China.

PMID: 31296477
DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.011

Abstract

Background: The purpose of this study was to validate and pilot the use of the four-variable screening tool (4V) and modified 4V tools to identify acute ischemic stroke and transient ischemic attack (TIA) patients at high risk of obstructive sleep apnea (OSA).

Methods: Two modified scales, 4V-1 (ie, using neck circumference instead body mass index, regardless of gender) and 4V-2 (ie, as above but scored differently according to gender) were designed. These tools were used in a consecutive cohort of 124 acute ischemic stroke/TIA patients, together with the 4V-1, 4V-2, 4V, as well as the STOP-BANG, the Berlin questionnaire, and the Epworth Sleepiness Scale (ESS). Objective level 2 or level 3 polysomnography was used to confirm OSA and its severity. Both questionnaires and polysomnography were completed within 1 week from symptom onset.

Results: Area under the curve (AUC) of 4V was 0.807 (P< .0001) while AUC of STOP-BANG, Berlin Questionnaire and ESS were .701 (P< .0001), .704 (P< .0001) and .576 (P = .1556), respectively. AUC of 4V was greater than of STOP-BANG (z = 2.200, P = .0220), Berlin (z = 2.024, P = .0430) and ESS (z = 3.363, P = .0003). AUC of modified 4V-1 and modified 4V-2 were .824 (P< .001) and .835 (P< .001), respectively. Performance of modified 4V-2 was higher versus modified 4V-1 (z = 2.111, P = .0348) and higher but not significantly so to regular 4V (z = 1.784, P = .0744).

Conclusions: Neck circumference scored by gender is a useful substitution to body mass index in the 4V when screening OSA at early stages of ischemic stroke/TIA patients.

Keywords: Obstructive sleep apnea; acute ischemic stroke; four-variable screening tool; transient ischemic attack.

Publication types

Validation Study

MeSH terms

Aged
Blood Pressure
Body Mass Index
Brain Ischemia / complications
Brain Ischemia / diagnosis*
Brain Ischemia / physiopathology
Decision Support Techniques*
Female
Humans
Ischemic Attack, Transient / complications
Ischemic Attack, Transient / diagnosis*
Ischemic Attack, Transient / physiopathology
Male
Middle Aged
Neck / pathology*
Pilot Projects
Polysomnography
Predictive Value of Tests
Prognosis
Reproducibility of Results
Risk Assessment
Risk Factors
Severity of Illness Index
Sex Factors
Sleep Apnea, Obstructive / diagnosis
Sleep Apnea, Obstructive / etiology*
Sleep Apnea, Obstructive / physiopathology
Snoring / physiopathology
Stroke / complications
Stroke / diagnosis*
Stroke / physiopathology
Surveys and Questionnaires