A decision rule for diagnostic testing in obstructive sleep apnea.

Obstructive sleep apnea (OSA) is traditionally diagnosed using overnight polysomnography. Decision rules may provide an alternative to polysomnography. A consecutive series of patients referred to a tertiary sleep center underwent prospective evaluation with the upper airway physical examination protocol, followed by determination of the respiratory disturbance index using a portable monitor. Seventy-five patients were evaluated with the upper airway physical examination protocol. Historic predictors included age, snoring, witnessed apneas, and hypertension. Physical examination-based predictors included body mass index, neck circumference, mandibular protrusion, thyro-rami distance, sterno-mental distance, sterno-mental displacement, thyro-mental displacement, cricomental space, pharyngeal grade, Sampsoon-Young classification, and over-bite. A decision rule was developed using three predictors: a cricomental space of 1.5 cm or less, a pharyngeal grade of more than II, and the presence of overbite. In patients with all three predictors (17%), the decision rule had a positive predictive value of 95% (95% confidence interval [CI], 75-100%) and a negative predictive value of 49% (95% CI, 35-63%). A cricomental space of more than 1.5 cm (27% of patients) excluded OSA (negative predictive value of 100%, 95% CI, 75-100%). Comparable performance was obtained in a validation sample of 50 patients referred for diagnostic testing. This decision rule provides a simple, reliable, and accurate method of identifying a subset patients with, and perhaps more importantly, without OSA.

[1]  G. Maislin,et al.  Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. , 2000, American journal of respiratory and critical care medicine.

[2]  F. García-Río,et al.  Sleep apnea and hypertension. , 2000, Chest.

[3]  W A Whitelaw,et al.  Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnoea , 2000, Thorax.

[4]  P. L. Smith,et al.  Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment. , 2000, American journal of respiratory and critical care medicine.

[5]  S. Redline,et al.  Improvement of mild sleep-disordered breathing with CPAP compared with conservative therapy. , 1998, American journal of respiratory and critical care medicine.

[6]  C Guilleminault,et al.  A Predictive Morphometric Model for the Obstructive Sleep Apnea Syndrome , 1997, Annals of Internal Medicine.

[7]  T. Young,et al.  Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. , 1997, Sleep.

[8]  A Smiley,et al.  Effects of nasal CPAP on simulated driving performance in patients with obstructive sleep apnoea. , 1997, Thorax.

[9]  K M Hla,et al.  Snoring as part of a dose-response relationship between sleep-disordered breathing and blood pressure. , 1996, Sleep.

[10]  M J Hensley,et al.  A community study of snoring and sleep-disordered breathing. Health outcomes. , 1995, American journal of respiratory and critical care medicine.

[11]  M J Hensley,et al.  A community study of snoring and sleep-disordered breathing. Prevalence. , 1995, American journal of respiratory and critical care medicine.

[12]  D. White,et al.  Assessment of accuracy and analysis time of a novel device to monitor sleep and breathing in the home. , 1995, Sleep.

[13]  D Savva,et al.  Prediction of difficult tracheal intubation. , 1995, British journal of anaesthesia.

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

[15]  S. Redline,et al.  Assessment of the validity and utility of a sleep-symptom questionnaire. , 1994, American journal of respiratory and critical care medicine.

[16]  J. Remmers,et al.  Digital monitoring of sleep-disordered breathing using snoring sound and arterial oxygen saturation. , 1993, The American review of respiratory disease.

[17]  H. Chou,et al.  Mandibulohyoid distance in difficult laryngoscopy. , 1993, British journal of anaesthesia.

[18]  A. Pack,et al.  Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. , 1993, The American review of respiratory disease.

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

[20]  D. Spiegelhalter,et al.  Predicting difficult intubation. , 1988, British journal of anaesthesia.

[21]  J. Remmers,et al.  Site of pharyngeal narrowing predicts outcome of surgery for obstructive sleep apnea. , 1993, The American review of respiratory disease.

[22]  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.

[23]  I. Stiell,et al.  Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. , 1993, JAMA.

[24]  G. Ferretti,et al.  Evaluation of the upper airway in sleep apnea syndrome. , 1992, Sleep.

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

[26]  J. Fleetham.  Upper airway imaging in relation to obstructive sleep apnea. , 1992, Clinics in chest medicine.

[27]  J. Szalai,et al.  Are history and physical examination a good screening test for sleep apnea? , 1991, Annals of internal medicine.

[28]  A. Williams,et al.  Screening for sleep apnea using pulse oximetry and a clinical score. , 1991, Chest.

[29]  D. Hillman,et al.  Association of sleep apnoea with myocardial infarction in men , 1990, The Lancet.

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

[31]  Arthur S Slutsky,et al.  Do patients with obstructive sleep apnea have thick necks? , 1990, The American review of respiratory disease.

[32]  David Pee,et al.  Return to a Note on Screening Regression Equations , 1989 .

[33]  F. Hsieh,et al.  Sample size tables for logistic regression. , 1989, Statistics in medicine.

[34]  D. Spiegelhalter,et al.  Predicting difficult intubation. , 1988, British journal of anaesthesia.

[35]  M Partinen,et al.  Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. , 1988, Chest.

[36]  L. Findley,et al.  Automobile accidents involving patients with obstructive sleep apnea. , 1988, The American review of respiratory disease.

[37]  M. Kryger,et al.  Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. , 1988, Chest.

[38]  M. Kryger,et al.  SLEEP APNOEA PATIENTS HAVE MORE AUTOMOBILE ACCIDENTS , 1987, The Lancet.

[39]  J. R. Young,et al.  Difficult tracheal intubation: a retrospective study , 1987, Anaesthesia.

[40]  P. Yates.  Snoring as a risk factor for ischemic heart disease and stroke in men. , 1987, British medical journal.

[41]  L. Gugino,et al.  A clinical sign to predict difficult tracheal intubation: a prospective study. , 1986, Canadian Anaesthetists' Society journal.

[42]  A. Gorin,et al.  Undiagnosed sleep apnea in patients with essential hypertension. , 1985, Annals of internal medicine.