Screening for Severe Obstructive Sleep Apnea Syndrome in Hypertensive Outpatients

Authors

  • Indira Gurubhagavatula MD, MPH,

    1. Pulmonary and Critical Care and Sleep Section, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
    2. Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania
    3. Division of Sleep Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Barry G. Fields MD,

    Corresponding author
    1. Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania
    2. Division of Sleep Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
    • Pulmonary and Critical Care and Sleep Section, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
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  • Christian R Morales MD,

    1. Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania
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  • Sharon Hurley BA,

    1. Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania
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  • Grace W Pien MD, MSCE,

    1. Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania
    2. Division of Sleep Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Lindsay C. Wick MS,

    1. Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania
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  • Bethany A. Staley BA,

    1. Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania
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  • Raymond R Townsend MD,

    1. Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Greg Maislin MS, MA

    1. Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania
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Address for correspondence: Barry G. Fields, MD, Center for Sleep and Circadian Neurobiology, 3624 Market Street, Suite 205, Philadelphia, PA 19104

E-mail: barry.fields@uphs.upenn.edu

Abstract

The authors attempted to validate a 2-stage strategy to screen for severe obstructive sleep apnea syndrome (s-OSAS) among hypertensive outpatients, with polysomnography (PSG) as the gold standard. Using a prospective design, outpatients with hypertension were recruited from medical outpatient clinics. Interventions included (1) assessment of clinical data; (2) home sleep testing (HST); and (3) 12-channnel, in-laboratory PSG. The authors developed models using clinical or HST data alone (single-stage models) or clinical data in tandem with HST (2-stage models) to predict s-OSAS. For each model, area under receiver operating characteristic curves (AUCs), sensitivity, specificity, negative likelihood ratio, and negative post-test probability (NPTP) were computed. Models were then rank-ordered based on AUC values and NPTP. HST used alone had limited accuracy (AUC=0.727, NPTP=2.9%). However, models that used clinical data in tandem with HST were more accurate in identifying s-OSAS, with lower NPTP: (1) facial morphometrics (AUC=0.816, NPTP=0.6%); (2) neck circumference (AUC=0.803, NPTP=1.7%); and Multivariable Apnea Prediction Score (AUC=0.799, NPTP=1.5%) where sensitivity, specificity, and NPTP were evaluated at optimal thresholds. Therefore, HST combined with clinical data can be useful in identifying s-OSAS in hypertensive outpatients, without incurring greater cost and patient burden associated with in-laboratory PSG. These models were less useful in identifying obstructive sleep apnea syndrome of any severity.

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