Prospective testing of two models based on clinical and oximetric variables for prediction of obstructive sleep apnea.

STUDY OBJECTIVE To test the validity of two models for prediction of obstructive sleep apnea syndrome (OSAS) before polysomnography. DESIGN Prospective study. SETTING Sleep laboratory in an obesity clinic. PATIENTS Data from two populations were analyzed: the first (group 1) included 102 consecutive overweight patients referred to our laboratory by an obesity clinic between May 1992 and November 1994, and was used to develop the prediction models. The second (group 2) included 108 consecutive new patients referred to our laboratory by the same obesity clinic between February 1997 and September 1998, and was used to test the prediction models. MEASUREMENTS AND RESULTS Models were developed using a clinical score, pulmonary function tests, arterial blood gas tensions, and nocturnal pulse oximetry. OSAS was defined by an apnea-hypopnea index (AHI) > 15 events per hour, as measured by full-night polysomnography. Step-by-step multiple linear regression analysis (MLR) was used to provide an equation for calculation of predicted AHI, while logistic regression analysis (LR) provided an equation for calculation of the probability (P') of having OSAS. Characteristics of groups 1 and 2 were similar except for the prevalence of OSAS, which was higher in group 2 (74% vs 39% in group 1). The negative predictive value (NPV) of the MLR model dropped from 82.9% in group 1 to 36.7% in group 2. In parallel, the NPV of a P' < 0.25 according to LR decreased from 78.6% in group 1 to 23.5% in group 2. CONCLUSION Our results emphasize the need for systematic prospective testing of mathematical predictive models in OSAS, since their diagnostic characteristics may differ markedly between populations, even when the setting and mode of recruitment remain unchanged.

[1]  N Roche,et al.  Value of clinical, functional, and oximetric data for the prediction of obstructive sleep apnea in obese patients. , 1999, Chest.

[2]  K. Ferguson,et al.  Neural network prediction of obstructive sleep apnea from clinical criteria. , 1999, Chest.

[3]  L. Olson,et al.  Prediction of sleep‐disordered breathing by unattended overnight oximetry , 1999, Journal of sleep research.

[4]  D. Shucard,et al.  Validity of neural network in sleep apnea. , 1999, Sleep.

[5]  M. Kvasz,et al.  Systematic review of the literature regarding the diagnosis of sleep apnea. , 1998, Evidence report/technology assessment.

[6]  L. Epstein,et al.  Cost-effectiveness analysis of nocturnal oximetry as a method of screening for sleep apnea-hypopnea syndrome. , 1998, Chest.

[7]  B Lüderitz,et al.  Predictive diagnostic value of clinical assessment and nonlaboratory monitoring system recordings in patients with symptoms suggestive of obstructive sleep apnea syndrome. , 1997, Respiration; international review of thoracic diseases.

[8]  C. Brambilla,et al.  Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. , 1996, Chest.

[9]  W. McNicholas,et al.  Predictive value of clinical features for the obstructive sleep apnoea syndrome. , 1996, The European respiratory journal.

[10]  A. Pack,et al.  A survey screen for prediction of apnea. , 1995, Sleep.

[11]  D. Rapoport,et al.  Clinical Diagnosis of Pediatric Obstructive Sleep Apnea Validated by Polysomnography , 1994, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[12]  W. Flemons,et al.  Likelihood ratios for a sleep apnea clinical prediction rule. , 1994, American journal of respiratory and critical care medicine.

[13]  C. E. Santaolalla,et al.  Validez de un sistema de registro portátil (MESAM IV) para el diagnóstico del síndrome de apnea del sueño , 1994 .

[14]  C. E. Egea Santaolalla,et al.  [Validity of a portable recording system (MESAM IV) for the diagnosis of sleep apnea syndrome]. , 1994, Archivos de bronconeumologia.

[15]  F. Sériès,et al.  Utility of Nocturnal Home Oximetry for Case Finding in Patients with Suspected Sleep Apnea Hypopnea Syndrome , 1993, Annals of Internal Medicine.

[16]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[17]  H. Zwick,et al.  Model for investigating snorers with suspected sleep apnoea. , 1993, Thorax.

[18]  M J Hensley,et al.  A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea. , 1993, The American review of respiratory disease.

[19]  J. Stradling,et al.  Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. , 1992, Thorax.

[20]  N. Saunders,et al.  Estimation of the probability of disturbed breathing during sleep before a sleep study. , 1990, The American review of respiratory disease.

[21]  J. Stradling,et al.  The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome. , 1990, The European respiratory journal.