Rapid risk stratification for obstructive sleep apnea, based on snoring severity and body mass index
Received 8 June 2008; received in revised form 20 August 2008; accepted 21 August 2008.
Objective
It is unclear whether all snoring patients require polysomnography, and there are no highly sensitive clinical predictors of sleep apnea. Our objective was to develop a simple clinical screening test for OSA in snoring patients.
Study Design
Prospective, IRB-approved study at a university sleep disorders center.
Subjects and Methods
In 211 patients undergoing polysomnography, snoring severity, Epworth sleepiness scale, body mass index, demographic, and sleep study data were collected. Receiver operating characteristic (ROC) analysis and Pearson correlation were used to develop a sensitive screening test for OSA.
Results
Snoring severity score (SSS) and BMI were the two most accurate predictors of OSA on the ROC curve. A bipartite threshold of SSS = 4 or BMI = 26 carried sensitivity of 97.4%, specificity of 40%, positive predictive value of 82.3%, and negative predictive value of 84.2% for moderate/severe OSA. Patients at high risk were those with BMI ≥32 (89% PPV) or SSS ≥7 (92% PPV).
Conclusions
The statistic most predictive of OSA was snoring severity. Combining this with BMI yielded a highly sensitive screening test for moderate/severe OSA. This clinical assessment may be useful in risk-stratifying patients for polysomnography and therapy, facilitating deferred work-up in low-risk patients and expedited therapy in high-risk patients.
aDivision of Sleep Medicine & Surgery, Department of Otolaryngology, New York University School of Medicine, New York, NY
bSleep Disorders Center, Division of Pulmonary Medicine, Department of Medicine, New York University School of Medicine, New York, NY
cDepartment of Otolaryngology–Head and Neck Surgery, Lenox Hill Hospital, New York, NY
Corresponding author: Luc G.T. Morris, MD, Department of Otolaryngology, New York University School of Medicine, 550 First Avenue, NBV 5E5, New York, NY 10016
ABSTRACT