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Sleep Disorders |

Utility of the "Elbow Sign" in the Diagnosis of Obstructive Sleep Apnea

Mark Fenton*, MD; Karen Heathcote, MD; Robert Skomro, MD; John Reid, MD; John Gjevre, MD; David Cotton, MD; Rhonda Bryce, MD; Mike Smith, MMSc; Hyun Lim, PhD
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University of Saskatchewan, Saskatoon, SK, Canada


Chest. 2012;142(4_MeetingAbstracts):1058A. doi:10.1378/chest.1386315
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Abstract

SESSION TYPE: Sleep Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Several questionnaires have been used to predict the diagnosis of obstructive sleep apnea (OSA). Such models typically have multiple questions that can be cumbersome in the clinical setting. We wanted to determine if a simple two part questionnaire has predictive value in the pre-test clinical evaluation for obstructive sleep apnea.

METHODS: A questionnaire consisting of two questions - 1) Does your bed-partner ever poke or elbow you because you are snoring and 2) Does your bed-partner ever poke or elbow you because you have stopped breathing? - was prospectively administered to patients being evaluated in a Sleep Disorders Clinic prior to undergoing polysomnography (PSG). Age, sex, body mass index (BMI), and Epworth Score (ES) were collected. Statistical analysis was done using SPSS-19.

RESULTS: 124 patients completed the questionnaire and went on to have a PSG. Answering ‘yes’ to being awakened for snoring increased the likelihood of an apnea-hypopnea index (AHI) >5/hour 3.7 times compared to ‘no’. Answering ‘yes’ to being awakened for apneic spells was associated with a likelihood ratio of 6.1 for an AHI >5/hour compared to ‘no’. These associations were not influenced by age, sex, BMI, ES or answering ‘yes’ to the other question. Chi square analysis showed that as disease severity (AHI<5, AHI=5-14.9, AHI=15-29.9, AHI≥30) increases patients are more likely to be awakened for snoring (p=0.001) and apneic spells (p<0.001). The sensitivity and specificity of being awakened for snoring was 84% and 41% respectively. The sensitivity and specificity of being awakened for apneic spells was 65% and 77% respectively with a positive predictive value of 90%.

CONCLUSIONS: Simply asking if a patient’s bed-partner awakens them because of snoring and apneic spells in the outpatient clinic significantly improves the pretest prediction of an individual having an AHI >5/hour on PSG.

CLINICAL IMPLICATIONS: This simple, easy to remember questionnaire significantly improves the pretest prediction of a diagnosis of OSA in the outpatient clinic.

DISCLOSURE: The following authors have nothing to disclose: Mark Fenton, Karen Heathcote, Robert Skomro, John Reid, John Gjevre, David Cotton, Rhonda Bryce, Mike Smith, Hyun Lim

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University of Saskatchewan, Saskatoon, SK, Canada

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