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Published in: Sleep and Breathing 2/2023

28-04-2022 | Sleep Apnea | Sleep Breathing Physiology and Disorders • Original Article

BASH-GN: a new machine learning–derived questionnaire for screening obstructive sleep apnea

Authors: Jiayan Huo, Stuart F. Quan, Janet Roveda, Ao Li

Published in: Sleep and Breathing | Issue 2/2023

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Abstract

Purpose

This study aimed to develop a machine learning–based questionnaire (BASH-GN) to classify obstructive sleep apnea (OSA) risk by considering risk factor subtypes.

Methods

Participants who met study inclusion criteria were selected from the Sleep Heart Health Study Visit 1 (SHHS 1) database. Other participants from the Wisconsin Sleep Cohort (WSC) served as an independent test dataset. Participants with an apnea hypopnea index (AHI) ≥ 15/h were considered as high risk for OSA. Potential risk factors were ranked using mutual information between each factor and the AHI, and only the top 50% were selected. We classified the subjects into 2 different groups, low and high phenotype groups, according to their risk scores. We then developed the BASH-GN, a machine learning–based questionnaire that consists of two logistic regression classifiers for the 2 different subtypes of OSA risk prediction.

Results

We evaluated the BASH-GN on the SHHS 1 test set (n = 1237) and WSC set (n = 1120) and compared its performance with four commonly used OSA screening questionnaires, the Four-Variable, Epworth Sleepiness Scale, Berlin, and STOP-BANG. The model outperformed these questionnaires on both test sets regarding the area under the receiver operating characteristic (AUROC) and the area under the precision-recall curve (AUPRC). The model achieved AUROC (SHHS 1: 0.78, WSC: 0.76) and AUPRC (SHHS 1: 0.72, WSC: 0.74), respectively. The questionnaire is available at https://​c2ship.​org/​bash-gn.

Conclusion

Considering OSA subtypes when evaluating OSA risk may improve the accuracy of OSA screening.
Appendix
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Literature
1.
go back to reference Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014CrossRefPubMedPubMedCentral Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014CrossRefPubMedPubMedCentral
2.
go back to reference Gottlieb DJ, Punjabi NM (2020) Diagnosis and management of obstructive sleep apnea: a review. JAMA 323:1389–1400CrossRefPubMed Gottlieb DJ, Punjabi NM (2020) Diagnosis and management of obstructive sleep apnea: a review. JAMA 323:1389–1400CrossRefPubMed
3.
go back to reference Al Lawati NM, Patel SR, Ayas NT (2009) Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis 51:285–293CrossRefPubMed Al Lawati NM, Patel SR, Ayas NT (2009) Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis 51:285–293CrossRefPubMed
4.
go back to reference Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, Wadden TA, Kelley D, Wing RR, Sunyer FXP (2009) Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 32:1017–1019CrossRefPubMedPubMedCentral Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, Wadden TA, Kelley D, Wing RR, Sunyer FXP (2009) Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 32:1017–1019CrossRefPubMedPubMedCentral
5.
go back to reference Harris M, Glozier N, Ratnavadivel R, Grunstein RR (2009) Obstructive sleep apnea and depression. Sleep Med Rev 13:437–444CrossRefPubMed Harris M, Glozier N, Ratnavadivel R, Grunstein RR (2009) Obstructive sleep apnea and depression. Sleep Med Rev 13:437–444CrossRefPubMed
8.
go back to reference Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea: the Epworth Sleepiness Scale. Chest 103:30–36CrossRefPubMed Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea: the Epworth Sleepiness Scale. Chest 103:30–36CrossRefPubMed
9.
go back to reference Takegami M, Hayashino Y, Chin K, Sokejima S, Kadotani H, Akashiba T, Kimura H, Ohi M, Fukuhara S (2009) Simple four-variable screening tool for identification of patients with sleep-disordered breathing. Sleep 32:939–948PubMedPubMedCentral Takegami M, Hayashino Y, Chin K, Sokejima S, Kadotani H, Akashiba T, Kimura H, Ohi M, Fukuhara S (2009) Simple four-variable screening tool for identification of patients with sleep-disordered breathing. Sleep 32:939–948PubMedPubMedCentral
10.
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 131:485–491CrossRefPubMed 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 131:485–491CrossRefPubMed
11.
go back to reference Ong TH, Raudha S, Fook-Chong S, Lew N, Hsu A (2010) Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population. Sleep and Breathing 14:371–376CrossRefPubMed Ong TH, Raudha S, Fook-Chong S, Lew N, Hsu A (2010) Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population. Sleep and Breathing 14:371–376CrossRefPubMed
12.
go back to reference Keenan BT, Kim J, Singh B, Bittencourt L, Chen NH, Cistulli PA, Magalang UJ, McArdle N, Mindel JW, Benediktsdottir B, Arnardottir ES, Prochnow LK, Penzel T, Sanner B, Schwab RJ, Shin C, Sutherland K, Tufik S, Maislin G, Gislason T, Pack AI (2018) Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis. Sleep 41. https://doi.org/10.1093/sleep/zsx214 Keenan BT, Kim J, Singh B, Bittencourt L, Chen NH, Cistulli PA, Magalang UJ, McArdle N, Mindel JW, Benediktsdottir B, Arnardottir ES, Prochnow LK, Penzel T, Sanner B, Schwab RJ, Shin C, Sutherland K, Tufik S, Maislin G, Gislason T, Pack AI (2018) Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis. Sleep 41. https://​doi.​org/​10.​1093/​sleep/​zsx214
14.
go back to reference Quan SF, Howard BV, Iber C, Kiley JP, Nieto FJ, O’Connor GT, Rapoport DM, Redline S, Robbins J, Samet JM (1997) The sleep heart health study: design, rationale, and methods. Sleep 20:1077–1085PubMed Quan SF, Howard BV, Iber C, Kiley JP, Nieto FJ, O’Connor GT, Rapoport DM, Redline S, Robbins J, Samet JM (1997) The sleep heart health study: design, rationale, and methods. Sleep 20:1077–1085PubMed
15.
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 Off Publ State Med Soc Wis 108:246 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 Off Publ State Med Soc Wis 108:246
16.
go back to reference Zhang G-Q, Cui L, Mueller R, Tao S, Kim M, Rueschman M, Mariani S, Mobley D, Redline S (2018) The National Sleep Research Resource: towards a sleep data commons. J Am Med Inform Assoc 25:1351–1358CrossRefPubMedPubMedCentral Zhang G-Q, Cui L, Mueller R, Tao S, Kim M, Rueschman M, Mariani S, Mobley D, Redline S (2018) The National Sleep Research Resource: towards a sleep data commons. J Am Med Inform Assoc 25:1351–1358CrossRefPubMedPubMedCentral
17.
go back to reference Yaggi HK, Strohl KP (2010) Adult obstructive sleep apnea/hypopnea syndrome: definitions, risk factors, and pathogenesis. Clin Chest Med 31:179CrossRefPubMed Yaggi HK, Strohl KP (2010) Adult obstructive sleep apnea/hypopnea syndrome: definitions, risk factors, and pathogenesis. Clin Chest Med 31:179CrossRefPubMed
18.
go back to reference Koo P, McCool FD, Hale L, Stone K, Eaton CB (2016) Association of obstructive sleep apnea risk factors with nocturnal enuresis in postmenopausal women. Menopause (New York, NY) 23:175CrossRef Koo P, McCool FD, Hale L, Stone K, Eaton CB (2016) Association of obstructive sleep apnea risk factors with nocturnal enuresis in postmenopausal women. Menopause (New York, NY) 23:175CrossRef
19.
go back to reference Young T, Skatrud J, Peppard PE (2004) Risk factors for obstructive sleep apnea in adults. JAMA 291:2013–2016CrossRefPubMed Young T, Skatrud J, Peppard PE (2004) Risk factors for obstructive sleep apnea in adults. JAMA 291:2013–2016CrossRefPubMed
21.
go back to reference Buman MP, Kline CE, Youngstedt SD, Phillips B, De Mello MT, Hirshkowitz M (2015) Sitting and television viewing: novel risk factors for sleep disturbance and apnea risk? Results from the 2013 National Sleep Foundation Sleep in America Poll. Chest 147:728–734CrossRefPubMedPubMedCentral Buman MP, Kline CE, Youngstedt SD, Phillips B, De Mello MT, Hirshkowitz M (2015) Sitting and television viewing: novel risk factors for sleep disturbance and apnea risk? Results from the 2013 National Sleep Foundation Sleep in America Poll. Chest 147:728–734CrossRefPubMedPubMedCentral
22.
go back to reference Millman RP, Redline S, Carlisle CC, Assaf AR, Levinson PD (1991) Daytime hypertension in obstructive sleep apnea: prevalence and contributing risk factors. Chest 99:861–866CrossRefPubMed Millman RP, Redline S, Carlisle CC, Assaf AR, Levinson PD (1991) Daytime hypertension in obstructive sleep apnea: prevalence and contributing risk factors. Chest 99:861–866CrossRefPubMed
25.
go back to reference Kale SS, Kakodkar P, Shetiya SH (2018) Assessment of oral findings of dental patients who screen high and no risk for obstructive sleep apnea (OSA) reporting to a dental college-a cross sectional study. Sleep Science 11:112CrossRefPubMedPubMedCentral Kale SS, Kakodkar P, Shetiya SH (2018) Assessment of oral findings of dental patients who screen high and no risk for obstructive sleep apnea (OSA) reporting to a dental college-a cross sectional study. Sleep Science 11:112CrossRefPubMedPubMedCentral
26.
go back to reference Chung F, Abdullah HR, Liao P (2016) STOP-BANG questionnaire: a practical approach to screen for obstructive sleep apnea. Chest 149:631–638CrossRefPubMed Chung F, Abdullah HR, Liao P (2016) STOP-BANG questionnaire: a practical approach to screen for obstructive sleep apnea. Chest 149:631–638CrossRefPubMed
27.
go back to reference Silva GE, Vana KD, Goodwin JL, Sherrill DL, Quan SF (2011) Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-BANG, and Epworth Sleepiness Scales. J Clin Sleep Med 7:467–472 Silva GE, Vana KD, Goodwin JL, Sherrill DL, Quan SF (2011) Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-BANG, and Epworth Sleepiness Scales. J Clin Sleep Med 7:467–472
28.
go back to reference Davis J, Goadrich M (2006) The relationship between Precision-Recall and ROC curves. Proceedings of the 23rd international conference on Machine learning, pp 233–240 Davis J, Goadrich M (2006) The relationship between Precision-Recall and ROC curves. Proceedings of the 23rd international conference on Machine learning, pp 233–240
29.
go back to reference Nagappa M, Wong J, Singh M, Wong DT, Chung F (2017) An update on the various practical applications of the STOP-BANG questionnaire in anesthesia, surgery, and perioperative medicine. Curr Opin Anaesthesiol 30:118CrossRefPubMedPubMedCentral Nagappa M, Wong J, Singh M, Wong DT, Chung F (2017) An update on the various practical applications of the STOP-BANG questionnaire in anesthesia, surgery, and perioperative medicine. Curr Opin Anaesthesiol 30:118CrossRefPubMedPubMedCentral
30.
go back to reference Chowdhuri S, Quan SF, Almeida F, Ayappa I, Batool-Anwar S, Budhiraja R, Cruse PE, Drager LF, Griss B, Marshall N (2016) An official American Thoracic Society research statement: impact of mild obstructive sleep apnea in adults. Am J Respir Crit Care Med 193:e37-54CrossRefPubMed Chowdhuri S, Quan SF, Almeida F, Ayappa I, Batool-Anwar S, Budhiraja R, Cruse PE, Drager LF, Griss B, Marshall N (2016) An official American Thoracic Society research statement: impact of mild obstructive sleep apnea in adults. Am J Respir Crit Care Med 193:e37-54CrossRefPubMed
Metadata
Title
BASH-GN: a new machine learning–derived questionnaire for screening obstructive sleep apnea
Authors
Jiayan Huo
Stuart F. Quan
Janet Roveda
Ao Li
Publication date
28-04-2022
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 2/2023
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-022-02629-8

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