Skip to main content
Top
Published in: Sleep and Breathing 1/2020

Open Access 01-03-2020 | Sleep Apnea | Sleep Breathing Physiology and Disorders • Original Article

The use of oximetry and a questionnaire in primary care enables exclusion of a subsequent obstructive sleep apnea diagnosis

Authors: Timon M. Fabius, Jeffrey R. Benistant, Rick G. Pleijhuis, Job van der Palen, Michiel M. M. Eijsvogel

Published in: Sleep and Breathing | Issue 1/2020

Login to get access

Abstract

Purpose

The study aims to prospectively validate the prognostic value of oximetry alone or combined in a two-step strategy with a questionnaire for the exclusion of obstructive sleep apnea (OSA) in primary care.

Methods

A total of 140 subjects with suspected OSA were included from 54 participating primary care practices. All subjects completed the Philips questionnaire and underwent one night of oximetry prior to referral to a sleep center. The prognostic value of two strategies was evaluated against the diagnosis of the sleep center as the gold standard: (1) assume OSA and subsequently refer to a sleep center if the oxygen desaturation index (ODI) is ≥ 5 and (2) assume OSA and refer to a sleep center if the Philips questionnaire score is ≥ 55% (regardless of the ODI) or if the Philips questionnaire score is < 55% and the ODI is ≥ 5.

Results

OSA was diagnosed in the sleep centers in 100 (71%) of the included subjects. Using ODI ≥ 5 alone resulted in a sensitivity of 99.0%, a specificity of 50.0%, a negative predictive value of 95.2%, and a positive predictive value 83.2%. Using the two-step strategy, oximetry would be performed on 39% of the subjects. This strategy resulted in a sensitivity of 100%, a specificity of 35.0%, a negative predictive value of 100%, and a positive predictive value of 79.4%.

Conclusions

In a Dutch primary care population with a clinical suspicion of OSA and low frequency of cardiovascular comorbidities, the use of oximetry alone or combined in a two-step strategy with a questionnaire enables exclusion of a sleep center diagnosis of OSA.
Appendix
Available only for authorised users
Literature
1.
go back to reference McNicholas WT, Bonsigore MR, Bonsignore MR, Management Committee of EU COST ACTION B26 (2007) Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur. Respir. J. 29:156–178CrossRef McNicholas WT, Bonsigore MR, Bonsignore MR, Management Committee of EU COST ACTION B26 (2007) Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur. Respir. J. 29:156–178CrossRef
2.
go back to reference Hartenbaum N, Collop N, Rosen IM, Phillips B, George CFP, Rowley JA, Freedman N, Weaver TE, Gurubhagavatula I, Strohl K, Leaman HM, Moffitt GL, Rosekind MR (2006) Sleep apnea and commercial motor vehicle operators: statement from the joint task force of the American College of Chest Physicians, American College of Occupational and Environmental Medicine, and the National Sleep Foundation. J. Occup. Environ. Med. 48:S4–S37 Hartenbaum N, Collop N, Rosen IM, Phillips B, George CFP, Rowley JA, Freedman N, Weaver TE, Gurubhagavatula I, Strohl K, Leaman HM, Moffitt GL, Rosekind MR (2006) Sleep apnea and commercial motor vehicle operators: statement from the joint task force of the American College of Chest Physicians, American College of Occupational and Environmental Medicine, and the National Sleep Foundation. J. Occup. Environ. Med. 48:S4–S37
3.
go back to reference Jennum P, Kjellberg J (2011) Health, social and economical consequences of sleep-disordered breathing: a controlled national study. Thorax 66:560–566CrossRef Jennum P, Kjellberg J (2011) Health, social and economical consequences of sleep-disordered breathing: a controlled national study. Thorax 66:560–566CrossRef
4.
go back to reference Young T, Palta M, Dempsey J, Peppard PE, Nieto FJ, Hla KM (2009) Burden of sleep apnea: rationale, design, and major findings of the Wisconsin sleep cohort study. WMJ 108:246–249PubMedPubMedCentral Young T, Palta M, Dempsey J, Peppard PE, Nieto FJ, Hla KM (2009) Burden of sleep apnea: rationale, design, and major findings of the Wisconsin sleep cohort study. WMJ 108:246–249PubMedPubMedCentral
5.
go back to reference Kantar Public, Dutch Apnea Society (2018) Diagnosis and treatment of sleep apnea in sleep clinics 2018 (In Dutch, original title: “Diagnose en behandeling van apneu in slaapklinieken 2018”) Kantar Public, Dutch Apnea Society (2018) Diagnosis and treatment of sleep apnea in sleep clinics 2018 (In Dutch, original title: “Diagnose en behandeling van apneu in slaapklinieken 2018”)
6.
go back to reference Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108:812–821CrossRef Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108:812–821CrossRef
7.
go back to reference Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y (2012) High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br. J. Anaesth. 108:768–775CrossRef Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y (2012) High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br. J. Anaesth. 108:768–775CrossRef
8.
go back to reference Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann. Intern. Med. 131:485–491CrossRef Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann. Intern. Med. 131:485–491CrossRef
9.
go back to reference Rosenthal LD, Dolan DC (2008) The Epworth Sleepiness Scale in the identification of obstructive sleep apnea. J. Nerv. Ment. Dis. 196:429–431CrossRef Rosenthal LD, Dolan DC (2008) The Epworth Sleepiness Scale in the identification of obstructive sleep apnea. J. Nerv. Ment. Dis. 196:429–431CrossRef
10.
go back to reference Eijsvogel MM, Wiegersma S, Randerath W, Verbraecken J, Wegter-Hilbers E, van der Palen J (2016) Obstructive sleep apnea syndrome in company workers: development of a two-step screening strategy with a new questionnaire. J. Clin. Sleep Med. 12:555–564CrossRef Eijsvogel MM, Wiegersma S, Randerath W, Verbraecken J, Wegter-Hilbers E, van der Palen J (2016) Obstructive sleep apnea syndrome in company workers: development of a two-step screening strategy with a new questionnaire. J. Clin. Sleep Med. 12:555–564CrossRef
11.
go back to reference Kunisaki KM, Bohn OA, Wetherbee EE, Rector TS (2016) High-resolution wrist-worn overnight oximetry has high positive predictive value for obstructive sleep apnea in a sleep study referral population. Sleep Breath. 20:583–587CrossRef Kunisaki KM, Bohn OA, Wetherbee EE, Rector TS (2016) High-resolution wrist-worn overnight oximetry has high positive predictive value for obstructive sleep apnea in a sleep study referral population. Sleep Breath. 20:583–587CrossRef
12.
go back to reference Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J. Clin. Sleep Med. 5:263–276CrossRef Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J. Clin. Sleep Med. 5:263–276CrossRef
13.
go back to reference Eijsvogel MM, Schimsheimer RJ, Vos PJE, de Vries N, Raats CJI, Trooster R (2009) CBO Richtlijn diagnostiek en behandeling van het obstructief slaap apneu syndroom bij volwassenen (Dutch guideline for diagnosis and treatment of OSA in adults). Van Zuiden Communication, Alphen aan den Rijn Eijsvogel MM, Schimsheimer RJ, Vos PJE, de Vries N, Raats CJI, Trooster R (2009) CBO Richtlijn diagnostiek en behandeling van het obstructief slaap apneu syndroom bij volwassenen (Dutch guideline for diagnosis and treatment of OSA in adults). Van Zuiden Communication, Alphen aan den Rijn
14.
go back to reference Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American Academy of sleep medicine. J. Clin. Sleep Med. 8:597–619CrossRef Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American Academy of sleep medicine. J. Clin. Sleep Med. 8:597–619CrossRef
15.
go back to reference Fabius TM, Benistant JR, Bekkedam L, van der Palen J, de Jongh FHC, Eijsvogel MMM (2018) Validation of the oxygen desaturation index in the diagnostic workup of obstructive sleep apnea. Sleep Breath. 23(1):57–63CrossRef Fabius TM, Benistant JR, Bekkedam L, van der Palen J, de Jongh FHC, Eijsvogel MMM (2018) Validation of the oxygen desaturation index in the diagnostic workup of obstructive sleep apnea. Sleep Breath. 23(1):57–63CrossRef
16.
go back to reference Stöberl AS, Schwarz EI, Haile SR, Turnbull CD, Rossi VA, Stradling JR, Kohler M (2017) Night-to-night variability of obstructive sleep apnea. J. Sleep Res. 26(6):782–788 1–7CrossRef Stöberl AS, Schwarz EI, Haile SR, Turnbull CD, Rossi VA, Stradling JR, Kohler M (2017) Night-to-night variability of obstructive sleep apnea. J. Sleep Res. 26(6):782–788 1–7CrossRef
17.
go back to reference Geessinck FAJ, Pleijhuis RG, Mentink RJ, van der Palen J, Koffijberg H (2018) Cost-effectiveness analysis of the DiagnOSAS screening tool compared with polysomnography diagnosis in Dutch primary care. J. Clin. Sleep Med. 14:1005–1015CrossRef Geessinck FAJ, Pleijhuis RG, Mentink RJ, van der Palen J, Koffijberg H (2018) Cost-effectiveness analysis of the DiagnOSAS screening tool compared with polysomnography diagnosis in Dutch primary care. J. Clin. Sleep Med. 14:1005–1015CrossRef
18.
go back to reference Sánchez-Quiroga MÁ, Corral J, Gómez-de-Terreros FJ, Carmona-Bernal C, Asensio-Cruz MI, Cabello M, Martínez-Martínez MÁ, Egea CJ, Ordax E, Barbe F, Barca J, Masa JF, Fernández-Zapata G, Sánchez-Armengol Á, Caballero-Eraso C, Cantalejo O, Ocon R, Álvarez-Ruiz de Larrinaga A, Azpiazu M, Alonso-Alvarez ML, Tobajas L, Rubio M, González-Espárrago A, Lebrero-Ferreiro R, Hermosin-Bono T, Juan-Armas J, Crespo-Fidalgo P, de-la-Llama MH, Vega-Dominguez ME, Sánchez-Armengol Á, Alonso-Martínez ML, Álvarez-Ruiz de Larrinaga A, Fernández-Zapata G, Caballero-Eraso C, Cantalejo O, Ocon R, Azpiazu M, Tobajas L, Rubio M, González-Espárrago A, Lebrero-Ferreiro R, Hermosin-Bono T, Juan-Armas J, Crespo-Fidalgo P, de-la-Llama MH, Vega-Dominguez ME (2018) Primary care physicians can comprehensively manage sleep apnea patients: a non-inferiority randomized controlled trial. Am. J. Respir. Crit. Care Med. 198:648–656CrossRef Sánchez-Quiroga MÁ, Corral J, Gómez-de-Terreros FJ, Carmona-Bernal C, Asensio-Cruz MI, Cabello M, Martínez-Martínez MÁ, Egea CJ, Ordax E, Barbe F, Barca J, Masa JF, Fernández-Zapata G, Sánchez-Armengol Á, Caballero-Eraso C, Cantalejo O, Ocon R, Álvarez-Ruiz de Larrinaga A, Azpiazu M, Alonso-Alvarez ML, Tobajas L, Rubio M, González-Espárrago A, Lebrero-Ferreiro R, Hermosin-Bono T, Juan-Armas J, Crespo-Fidalgo P, de-la-Llama MH, Vega-Dominguez ME, Sánchez-Armengol Á, Alonso-Martínez ML, Álvarez-Ruiz de Larrinaga A, Fernández-Zapata G, Caballero-Eraso C, Cantalejo O, Ocon R, Azpiazu M, Tobajas L, Rubio M, González-Espárrago A, Lebrero-Ferreiro R, Hermosin-Bono T, Juan-Armas J, Crespo-Fidalgo P, de-la-Llama MH, Vega-Dominguez ME (2018) Primary care physicians can comprehensively manage sleep apnea patients: a non-inferiority randomized controlled trial. Am. J. Respir. Crit. Care Med. 198:648–656CrossRef
19.
go back to reference Chai-Coetzer CL, Antic NA, Rowland LS, Reed RL, Esterman A, Catcheside PG, Eckermann S, Vowles N, Williams H, Dunn S, McEvoy RD (2013) Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life: a randomized trial. JAMA 309:997–1004CrossRef Chai-Coetzer CL, Antic NA, Rowland LS, Reed RL, Esterman A, Catcheside PG, Eckermann S, Vowles N, Williams H, Dunn S, McEvoy RD (2013) Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life: a randomized trial. JAMA 309:997–1004CrossRef
20.
go back to reference Chai-Coetzer CL, Antic NA, Hamilton GS, McArdle N, Wong K, Yee BJ, Yeo A, Ratnavadivel R, Naughton MT, Roebuck T, Woodman R, McEvoy RD (2017) Physician decision making and clinical outcomes with laboratory polysomnography or Limited-Channel sleep studies for obstructive sleep apnea: a randomized trial. Ann. Intern. Med. 166:332–340CrossRef Chai-Coetzer CL, Antic NA, Hamilton GS, McArdle N, Wong K, Yee BJ, Yeo A, Ratnavadivel R, Naughton MT, Roebuck T, Woodman R, McEvoy RD (2017) Physician decision making and clinical outcomes with laboratory polysomnography or Limited-Channel sleep studies for obstructive sleep apnea: a randomized trial. Ann. Intern. Med. 166:332–340CrossRef
21.
go back to reference Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir. Med. 3:310–318CrossRef Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir. Med. 3:310–318CrossRef
22.
go back to reference Soldatos CR, Dikeos DG, Paparrigopoulos TJ (2000) Athens insomnia scale: validation of an instrument based on ICD-10 criteria. J. Psychosom. Res. 48:555–560CrossRef Soldatos CR, Dikeos DG, Paparrigopoulos TJ (2000) Athens insomnia scale: validation of an instrument based on ICD-10 criteria. J. Psychosom. Res. 48:555–560CrossRef
23.
go back to reference Theorell-Haglöw J, Miller CB, Bartlett DJ, Yee BJ, Openshaw HD, Grunstein RR (2018) Gender differences in obstructive sleep apnoea, insomnia and restless legs syndrome in adults—what do we know? A clinical update. Sleep Med. Rev. 38:28–38CrossRef Theorell-Haglöw J, Miller CB, Bartlett DJ, Yee BJ, Openshaw HD, Grunstein RR (2018) Gender differences in obstructive sleep apnoea, insomnia and restless legs syndrome in adults—what do we know? A clinical update. Sleep Med. Rev. 38:28–38CrossRef
Metadata
Title
The use of oximetry and a questionnaire in primary care enables exclusion of a subsequent obstructive sleep apnea diagnosis
Authors
Timon M. Fabius
Jeffrey R. Benistant
Rick G. Pleijhuis
Job van der Palen
Michiel M. M. Eijsvogel
Publication date
01-03-2020
Publisher
Springer International Publishing
Keywords
Sleep Apnea
Care
Published in
Sleep and Breathing / Issue 1/2020
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-019-01834-2

Other articles of this Issue 1/2020

Sleep and Breathing 1/2020 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.