A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study.
Adolescent
Adult
Aged
Continuous Positive Airway Pressure
Diagnostic Techniques and Procedures
Female
Health Status Indicators
Humans
Male
Middle Aged
Polysomnography
Primary Health Care
Prospective Studies
Referral and Consultation
/ statistics & numerical data
Sleep Apnea, Obstructive
/ diagnosis
Spain
Young Adult
Continuous positive airway pressure (CPAP)
Home sleep apnea test
Obstructive sleep apnea
Primary healthcare
Screening model
Sleep unit
Journal
BMC pulmonary medicine
ISSN: 1471-2466
Titre abrégé: BMC Pulm Med
Pays: England
ID NLM: 100968563
Informations de publication
Date de publication:
15 Jan 2022
15 Jan 2022
Historique:
received:
11
10
2021
accepted:
16
12
2021
entrez:
16
1
2022
pubmed:
17
1
2022
medline:
10
2
2022
Statut:
epublish
Résumé
The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting. Anthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the β coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed. 194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763-0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% ≥ 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863-0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7-92.1) and specificity of 67.8% (95% CI 55.1-78.3). The use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment. Clinical Trial Registration Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979 ; Identifier: NCT02591979. Date of registration: October 30, 2015.
Sections du résumé
BACKGROUND
BACKGROUND
The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting.
METHODS
METHODS
Anthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the β coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed.
RESULTS
RESULTS
194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763-0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% ≥ 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863-0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7-92.1) and specificity of 67.8% (95% CI 55.1-78.3).
CONCLUSIONS
CONCLUSIONS
The use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment. Clinical Trial Registration Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979 ; Identifier: NCT02591979. Date of registration: October 30, 2015.
Identifiants
pubmed: 35033055
doi: 10.1186/s12890-022-01827-0
pii: 10.1186/s12890-022-01827-0
pmc: PMC8761286
doi:
Banques de données
ClinicalTrials.gov
['NCT02591979']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
38Subventions
Organisme : fondo de investigaciones sanitarias
ID : PI 14/01985
Investigateurs
Leandra Domínguez Olivera
(L)
Pepi Valverde Trillo
(P)
MªÁngeles Santos Santos
(M)
Mª Del Mar Farga Martínez
(MDM)
Montserrat Reverté Simó
(M)
Núria Argemí Saburit
(N)
Casimira Medrano Medrano
(C)
Marineus Puig García
(M)
Informations de copyright
© 2022. The Author(s).
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