Comparisons of measures used to screen for obstructive sleep apnea in patients referred to a sleep clinic
Jennifer N. Miller a, *, Kevin A. Kupzyk b, 1, Lani Zimmerman b, 1, Bunny Pozehl b, 1, Paula Schulz b, 1, Debra Romberger b, 1, Ann M. Berger b, 1
a Nebraska Pulmonary Specialties, LLC, 1500 S. 48th St. #800, Lincoln, NE, 68506, USA
b The University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, 4111 Dewey Avenue, Omaha, NE, USA
Study objectives: Obstructive Sleep Apnea (OSA) contributes to all-cause mortality. An American Academy
of Sleep Medicine task force is focusing on improving detection and categorization of OSA symptoms
and severity to promote screening, assessment, and diagnosis. The purpose of this study was to psychometrically
compare measures used in OSA screening (Berlin, Epworth Sleepiness Scale (ESS), STOP
Bang) and a portable sleep monitor (PSM) to apnea-hypopnea index (AHI) and levels from polysomnogram
Methods: An observational, cross-sectional design was used. Patients referred to a sleep specialist were
enrolled at initial sleep evaluation. Participants completed measures used in OSA screening, then sent
home for one night using PSM. PSGs were ordered by the physician and AHI results were obtained from
the medical record.
Results: Participants (N ¼ 170) were enrolled in the study. Almost all participants completed the OSA
measures, approximately half-completed PSM measurement, and the majority completed laboratory
PSG. The STOP Bang had the highest levels of sensitivity; the ESS had the lowest. The ESS had the highest
specificity and reliability levels; the STOP Bang had the lowest. The PSM measure had the highest positive
predictive value (PPV) and the strongest psychometric properties of the screening measures.
Conclusions: The STOP Bang was the preferred self-report OSA screening measure because of high levels
of sensitivity. The ESS was the least desirable measure. PSM measurement consistently predicted the
presence of OSA but at the expense of low sensitivity at AHI levels 30. This expands the knowledge of
validity testing of screening measures used for OSA.
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