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__NOTOC__ | __NOTOC__ | ||
{{Sleep apnea}} | {{Sleep apnea}} | ||
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D. | |||
==Overview== | |||
[[Clinical practice guideline]]s by the [[United States Preventive Services Task Force]]<ref name="pmid28118461">US Preventive Services Task Force. Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW et al. (2017) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=28118461 Screening for Obstructive Sleep Apnea in Adults: US Preventive Services Task Force Recommendation Statement.] ''JAMA'' 317 (4):407-414. [http://dx.doi.org/10.1001/jama.2016.20325 DOI:10.1001/jama.2016.20325] PMID: [https://pubmed.gov/28118461 28118461]</ref> address screening and do not recommend screening. | |||
However, commercial drivers, operators of heavy equipment, pilots, and other occupations at risk of diurnal sleepiness should be screened by history and physical exam using standardizes questionnaires. | |||
==Obstructive Sleep Apnea Screening== | |||
*Commercial drivers, operators of heavy equipment, pilots, and other populations at risk from diurnal sleepiness should with be screened with a history and physical exam | |||
:*If OSA is suspected, a sleep study should be performed | |||
*For patients with obstructive sleep apnea, screening questionnaires may be useful for preoperative and high risk patients | |||
===STOP BANG questionnaire=== | |||
*Asks about the presence of loud snoring, apneas, excessive daytime sleepiness, and [[hypertension]] | |||
*STOP BANG questionnaire combines the STOP questionnaire questions and adds [[BMI]] age, and neck circumference (increased sensitivity but decreased specificity compared to STOP questionnaire) | |||
*A score of three or higher has a [[sensitivity]] and [[specificity]] of 84 and 56 percent for the diagnosis of OSA using an AHI threshold of >5 events per hour, and a sensitivity and specificity of 93 and 43 percent for an AHI >15 <ref name="pmid18431116">{{cite journal| author=Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S et al.| title=STOP questionnaire: a tool to screen patients for obstructive sleep apnea. | journal=Anesthesiology | year= 2008 | volume= 108 | issue= 5 | pages= 812-21 | pmid=18431116 | doi=10.1097/ALN.0b013e31816d83e4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18431116 }} </ref> | |||
*To view the STOP BANG questionnaire, click [http://www.sleepapnea.org/assets/files/pdf/STOP-BANG%20Questionnaire.pdf '''here'''] | |||
===Sleep apnea clinical score (SACS)=== | |||
*A four-item questionnaire that incorporates neck circumference, [[hypertension]], habitual snoring, and [[nocturnal]] gasping or choking to generate a score ranging from 0 to 100 | |||
*Scores greater than 15 result in a probability of OSA (defined as an AHI >10 events per hour) of 25 to 50 percent<ref name="pmid7952553">{{cite journal| author=Flemons WW, Whitelaw WA, Brant R, Remmers JE| title=Likelihood ratios for a sleep apnea clinical prediction rule. | journal=Am J Respir Crit Care Med | year= 1994 | volume= 150 | issue= 5 Pt 1 | pages= 1279-85 | pmid=7952553 | doi=10.1164/ajrccm.150.5.7952553 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7952553 }} </ref> | |||
===Berlin questionnaire=== | |||
*The Berlin questionnaire consists of 10 items relating to snoring, nonrestorative sleep, sleepiness while driving, apneas during sleep, [[hypertension]] and [[BMI]] | |||
*The results categorize patients as having a high or low risk for OSA | |||
*A high risk score is associated with a [[sensitivity]] and [[specificity]] of 80 and 46 percent when OSA is defined as an AHI ≥5 events per hour, and 91 and 37 percent when OSA is defined as an AHI ≥15 events per hour<ref name="pmid23989984">{{cite journal| author=Myers KA, Mrkobrada M, Simel DL| title=Does this patient have obstructive sleep apnea?: The Rational Clinical Examination systematic review. | journal=JAMA | year= 2013 | volume= 310 | issue= 7 | pages= 731-41 | pmid=23989984 | doi=10.1001/jama.2013.276185 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23989984 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24282174 Review in: Evid Based Med. 2014 Apr;19(2):e10] </ref> | |||
* To view the Berlin questionnaire, click [http://www.sleepapnea.org/assets/files/pdf/Berlin%20Questionnaire.pdf '''here'''] | |||
==Central Sleep Apnea Screening== | |||
There are no current screening guidelines for central sleep apnea. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
Clinical practice guidelines by the United States Preventive Services Task Force[1] address screening and do not recommend screening.
However, commercial drivers, operators of heavy equipment, pilots, and other occupations at risk of diurnal sleepiness should be screened by history and physical exam using standardizes questionnaires.
Obstructive Sleep Apnea Screening
- Commercial drivers, operators of heavy equipment, pilots, and other populations at risk from diurnal sleepiness should with be screened with a history and physical exam
- If OSA is suspected, a sleep study should be performed
- For patients with obstructive sleep apnea, screening questionnaires may be useful for preoperative and high risk patients
STOP BANG questionnaire
- Asks about the presence of loud snoring, apneas, excessive daytime sleepiness, and hypertension
- STOP BANG questionnaire combines the STOP questionnaire questions and adds BMI age, and neck circumference (increased sensitivity but decreased specificity compared to STOP questionnaire)
- A score of three or higher has a sensitivity and specificity of 84 and 56 percent for the diagnosis of OSA using an AHI threshold of >5 events per hour, and a sensitivity and specificity of 93 and 43 percent for an AHI >15 [2]
- To view the STOP BANG questionnaire, click here
Sleep apnea clinical score (SACS)
- A four-item questionnaire that incorporates neck circumference, hypertension, habitual snoring, and nocturnal gasping or choking to generate a score ranging from 0 to 100
- Scores greater than 15 result in a probability of OSA (defined as an AHI >10 events per hour) of 25 to 50 percent[3]
Berlin questionnaire
- The Berlin questionnaire consists of 10 items relating to snoring, nonrestorative sleep, sleepiness while driving, apneas during sleep, hypertension and BMI
- The results categorize patients as having a high or low risk for OSA
- A high risk score is associated with a sensitivity and specificity of 80 and 46 percent when OSA is defined as an AHI ≥5 events per hour, and 91 and 37 percent when OSA is defined as an AHI ≥15 events per hour[4]
- To view the Berlin questionnaire, click here
Central Sleep Apnea Screening
There are no current screening guidelines for central sleep apnea.
References
- ↑ US Preventive Services Task Force. Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW et al. (2017) Screening for Obstructive Sleep Apnea in Adults: US Preventive Services Task Force Recommendation Statement. JAMA 317 (4):407-414. DOI:10.1001/jama.2016.20325 PMID: 28118461
- ↑ Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S; et al. (2008). "STOP questionnaire: a tool to screen patients for obstructive sleep apnea". Anesthesiology. 108 (5): 812–21. doi:10.1097/ALN.0b013e31816d83e4. PMID 18431116.
- ↑ Flemons WW, Whitelaw WA, Brant R, Remmers JE (1994). "Likelihood ratios for a sleep apnea clinical prediction rule". Am J Respir Crit Care Med. 150 (5 Pt 1): 1279–85. doi:10.1164/ajrccm.150.5.7952553. PMID 7952553.
- ↑ Myers KA, Mrkobrada M, Simel DL (2013). "Does this patient have obstructive sleep apnea?: The Rational Clinical Examination systematic review". JAMA. 310 (7): 731–41. doi:10.1001/jama.2013.276185. PMID 23989984. Review in: Evid Based Med. 2014 Apr;19(2):e10