Sleep apnea screening: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 4: | Line 4: | ||
==Overview== | ==Overview== | ||
Although there are is no mandatory screening for patients suspected with sleep apnea, there are some recommended guidelines. For patients with obstructive sleep apnea, screening questionnaires are useful for preoperative patients and populations at risk for diurnal sleepiness. Regarding central sleep apnea, a continuous overnight ambulatory oximetry can help predict the prognosis in patients with CHF or cardiovascular disease. | Although there are is no mandatory screening for patients suspected with sleep apnea, there are some recommended guidelines. For patients with obstructive sleep apnea, screening questionnaires are useful for preoperative patients and populations at risk for [[diurnal]] sleepiness. Regarding central sleep apnea, a continuous overnight ambulatory [[oximetry]] can help predict the prognosis in patients with CHF or cardiovascular disease. | ||
==Sleep Apnea Screening== | ==Sleep Apnea Screening== | ||
| Line 13: | Line 13: | ||
::*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> | ::*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> | ||
:*Sleep apnea clinical score (SACS) | :*Sleep apnea clinical score (SACS) | ||
::*A four-item questionnaire that incorporates neck circumference, hypertension | ::*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 | :*Berlin questionnaire | ||
::*The Berlin questionnaire consists of 10 items relating to snoring, nonrestorative sleep, sleepiness while driving, apneas during sleep, hypertension | ::*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 | ::*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> | ::*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> | ||
| Line 23: | Line 24: | ||
:*If OSA is suspected, a sleep study should be performed | :*If OSA is suspected, a sleep study should be performed | ||
*For patients with central sleep apnea: | *For patients with central sleep apnea: | ||
:*Some centers recommend using continuous overnight ambulatory oximetry in patients with CHF or cardiovascular disease | :*Some centers recommend using continuous overnight ambulatory [[oximetry]] in patients with [[CHF]] or [[cardiovascular disease]] | ||
::*A patient with heart failure and central sleep apnea or Cheyne-Stokes breathing normally means a poorer prognosis | ::*A patient with heart failure and central sleep apnea or [[Cheyne-Stokes]] breathing normally means a poorer prognosis | ||
==References== | ==References== | ||
Revision as of 19:03, 7 July 2015
|
Sleep Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Sleep apnea screening On the Web |
|
American Roentgen Ray Society Images of Sleep apnea screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
Although there are is no mandatory screening for patients suspected with sleep apnea, there are some recommended guidelines. For patients with obstructive sleep apnea, screening questionnaires are useful for preoperative patients and populations at risk for diurnal sleepiness. Regarding central sleep apnea, a continuous overnight ambulatory oximetry can help predict the prognosis in patients with CHF or cardiovascular disease.
Sleep Apnea Screening
- For patients with obstructive sleep apnea, screening questionnaires may be useful for preoperative and high risk patients
- STOP 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 [1]
- 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[2]
- 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[3]
- 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 central sleep apnea:
- Some centers recommend using continuous overnight ambulatory oximetry in patients with CHF or cardiovascular disease
- A patient with heart failure and central sleep apnea or Cheyne-Stokes breathing normally means a poorer prognosis
References
- ↑ 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