SESSION TITLE: Sleep Disorders Poster Discussions
SESSION TYPE: Original Investigation Poster Discussion
PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM
PURPOSE: Unattended portable monitoring sleep study is widely used for diagnosis of obstructive sleep apnea (OSA). The STOP-BANG questionnaire is a well validated screening tool for diagnosis of OSA by an in- lab sleep study. However, performance of STOP-BANG as a screening tool for diagnosis of OSA in patients undergoing portable monitoring sleep study has not been well validated.
METHODS: We conducted a retrospective chart review of patients older than 18 years who had unattended portable monitoring sleep study done at a VA medical center between June 2012 and October 2014. STOP-BANG questionnaire and Epworth sleepiness scale (ESS) were routinely done prior to study. Sensitivity, specificity, and positive predictive value (PPV) various STOP-BANG score thresholds were calculated for diagnosis of OSA defined by Apnea Hyponea Index (AHI) ≥5.
RESULTS: Out of 502 unattended portable monitoring sleep studies, there were 465 males and 37 females; 327 males and 36 females had BMI ≥30; 442 patients had AHI ≥5 by unattended portable monitoring study. STOP-BANG thresholds of ≥2 and ≥3 have high sensitivity of 99.8%, and 98.9%, respectively, but very low specificity. Higher score thresholds of ≥7 and 8 have high specificity of 95% and 98.3%, and PPV of 98.1% and 98.5%, respectively, but very low sensitivity. A threshold of ≥7 in patients with BMI ≥30 was 100% specific. The false negative rate for unattended portable monitoring sleep study compared to in-lab study was 80%.
CONCLUSIONS: STOP-BANG score thresholds of ≥7 and 8 are highly specific and have high PPV and therefore can potentially reduce need of diagnostic sleep studies. Score thresholds of ≤2 or ≤3 are highly sensitive for AHI ≥5 by unattended portable monitoring sleep study. A negative result in a highly sensitive test rules out disease, but unattended portable monitoring study is not as sensitive as in-lab sleep study and therefore, for STOP-BANG scores ≤2 or ≤3 again one may move directly to an in-lab sleep study to rule out obstructive sleep apnea due to the high false positive rate of the unattended portable monitoring sleep study.
CLINICAL IMPLICATIONS: STOP-BANG score thresholds of ≥7 and 8 are highly specific and therefore can potentially reduce need of diagnostic sleep studies .For score thresholds of ≤2 or ≤3, one can avoid doing unattended portable monitoring and directly go for an in-lab study due to high false positive rate.
DISCLOSURE: The following authors have nothing to disclose: Viral Doshi, Reuben Walia, Christopher Parker, Ahmed Awab, Kellie Jones, Christopher Aston
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