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Original Research: Sleep Disorders |

Sex-Specific Prediction Models for Sleep Apnea From the Hispanic Community Health Study/Study of Latinos

Neomi Shah, MD, MPH; David B. Hanna, PhD; Yanping Teng, MD, MSPH; Daniela Sotres-Alvarez, PhD; Martica Hall, PhD; Jose S. Loredo, MD, MPH; Phyllis Zee, MD, PhD; Mimi Kim, ScD; H. Klar Yaggi, MD; Susan Redline, MD, MPH; Robert C. Kaplan, PhD
Author and Funding Information

Dr Shah is currently at the Icahn School of Medicine at Mount Sinai (New York, NY).

FUNDING/SUPPORT: The Hispanic Community Health Study/Study of Latinos was carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (N01-HC65233), University of Miami (N01-HC65234), Albert Einstein College of Medicine (N01-HC65235), Northwestern University (N01-HC65236), and San Diego State University (N01-HC65237). The following Institutes/Centers/Offices contribute to the HCHS/SOL through a transfer of funds to the NHLBI: National Institute on Minority Health and Health Disparities, National Institute on Deafness and Other Communication Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, NIH Institution-Office of Dietary Supplements.

CORRESPONDENCE TO: Neomi Shah, MD, MPH, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Pl, Box 1232, New York, NY 10029


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(6):1409-1418. doi:10.1016/j.chest.2016.01.013
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Objective  We developed and validated the first-ever sleep apnea (SA) risk calculator in a large population-based cohort of Hispanic/Latino subjects.

Methods  Cross-sectional data on adults from the Hispanic Community Health Study/Study of Latinos (2008-2011) were analyzed. Subjective and objective sleep measurements were obtained. Clinically significant SA was defined as an apnea-hypopnea index ≥ 15 events per hour. Using logistic regression, four prediction models were created: three sex-specific models (female-only, male-only, and a sex × covariate interaction model to allow differential predictor effects), and one overall model with sex included as a main effect only. Models underwent 10-fold cross-validation and were assessed by using the C statistic. SA and its predictive variables; a total of 17 variables were considered.

Results  A total of 12,158 participants had complete sleep data available; 7,363 (61%) were women. The population-weighted prevalence of SA (apnea-hypopnea index ≥ 15 events per hour) was 6.1% in female subjects and 13.5% in male subjects. Male-only (C statistic, 0.808) and female-only (C statistic, 0.836) prediction models had the same predictor variables (ie, age, BMI, self-reported snoring). The sex-interaction model (C statistic, 0.836) contained sex, age, age × sex, BMI, BMI × sex, and self-reported snoring. The final overall model (C statistic, 0.832) contained age, BMI, snoring, and sex. We developed two websites for our SA risk calculator: one in English (https://www.montefiore.org/sleepapneariskcalc.html) and another in Spanish (http://www.montefiore.org/sleepapneariskcalc-es.html).

Conclusions  We created an internally validated, highly discriminating, well-calibrated, and parsimonious prediction model for SA. Contrary to the study hypothesis, the variables did not have different predictive magnitudes in male and female subjects.

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