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01-09-2020 | Sleep Apnea | Sleep Breathing Physiology and Disorders • Original Article

Indication of CPAP without a sleep study in patients with high pretest probability of obstructive sleep apnea

Authors: Carlos Alberto Nigro, Eduardo Borsini, Eduardo Dibur, Luis Larrateguy, Alexis Cazaux, Carlos Elias, Marcelino de la Vega, Cecilia Berrozpe, Silvana Maggi, Sofía Grandval, Hugo Cambursano, Daniela Visentini, Magali Blanco, Glenda Ernst, Ignacio Bledel, Facundo Nogueira

Published in: Sleep and Breathing | Issue 3/2020

Abstract

Objective

To evaluate the performance of clinical criteria (CC) for diagnosis and initiation of empirical treatment with continuous positive airway pressure (CPAP) in patients with suspected obstructive sleep apnea (OSA) compared with the treatment decision based on sleep studies (polysomnography or respiratory polygraphy), guidelines, and experience of participating physicians.

Methods

This was a simulated intention-to-treat study in a retrospective (G1) and prospective (G2) cohort. Four observers (two per group) called CC1 and CC2 reviewed the sleep questionnaires and indicated CPAP if the patients presented snoring, frequent apneas (≥ 3–4/week), body mass index (BMI) > 25 kg/m², sleepiness (Epworth > 11), or tiredness (at least 3–4 times per week) and some comorbidity (hypertension, coronary/cerebrovascular event, diabetes). Ten independent observers formed two groups of five (FD1 and FD2) and were blinded to each other’s opinion. These observers in FD1 and FD2 decided CPAP treatment based on guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) or guidelines of the American Academy of Sleep Medicine (AASM) and factored in their own opinion. Sensitivity (S), specificity (Sp), and positive/negative likelihood ratios (LR+/−) were calculated with the test method: CC1/2, and the reference method: majority decision of FD1/2.

Results

A total of 653 patients (264 women, 40%) were studied. Median age was 54 years, BMI 28 kg/m², and apnea hypopnea index (AHI) 16.5 events/h. S ranged from 21 to 25% (p 0.60), Sp 96.1 to 97.6% (p 0.39), and LR+ of clinical criteria 6.4 to 8.9 (p 0.52).

Conclusion

CPAP indication without a previous sleep study showed a low sensitivity (≅ 22%) but a specificity greater than 95% in patients with high pretest probability for OSA (snoring, report of frequent apneas, BMI > 25 kg/m² and sleepiness or tiredness plus comorbidity).

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Title: Indication of CPAP without a sleep study in patients with high pretest probability of obstructive sleep apnea
Authors: Carlos Alberto Nigro
Eduardo Borsini
Eduardo Dibur
Luis Larrateguy
Alexis Cazaux
Carlos Elias
Marcelino de la Vega
Cecilia Berrozpe
Silvana Maggi
Sofía Grandval
Hugo Cambursano
Daniela Visentini
Magali Blanco
Glenda Ernst
Ignacio Bledel
Facundo Nogueira
Publication date: 01-09-2020
Publisher: Springer International Publishing
Keywords: Sleep Apnea
Polysomnography
Snoring
Published in: Sleep and Breathing / Issue 3/2020
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-019-01949-6

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