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. 2018 May 30;13(5):e0198315.
doi: 10.1371/journal.pone.0198315. eCollection 2018.

Screening for obstructive sleep apnea among hospital outpatients

Michel Hug  1 , Katrin Uehli  2 , Stig Solbach  1 , Stefanie Brighenti-Zogg  3 , Selina Dürr  3 , Sabrina Maier  3 , Jörg Daniel Leuppi  1   3 , David Miedinger  1   2   3
Affiliations

Screening for obstructive sleep apnea among hospital outpatients

Michel Hug et al. PLoS One. .

Abstract

Background: Obstructive sleep apnea syndrome (OSAS) is common in adults. People with OSAS have a higher risk of experiencing traffic accidents and occupational injuries (OIs). We aimed to clarify the diagnostic performance of a three-channel screening device (ApneaLinkTM) compared with the gold standard of full-night attended polysomnography (PSG) among hospital outpatients not referred for sleep-related symptoms. Furthermore, we aimed to determine whether manual revision of the ApneaLinkTM autoscore enhanced diagnostic performance.

Methods: We investigated 68 patients with OI and 44 without OI recruited from the University Hospital Basel emergency room, using a cross-sectional study design. Participating patients spent one night at home with ApneaLinkTM and within 2 weeks slept for one night at the sleep laboratory. We reanalyzed all ApneaLinkTM data after manual revision.

Results: We identified significant correlations between the ApneaLinkTM apnea-hypopnea index (AHI) autoscore and the AHI derived by PSG (r = 0.525; p <0.001) and between the ApneaLinkTM oxygen desaturation index (ODI) autoscore and that derived by PSG (r = 0.722; p <0.001). The ApneaLinkTM autoscore showed a sensitivity and specificity of 82% when comparing AHI ≥5 with the cutoff for AHI and/or ODI ≥15 from PSG. In Bland Altman plots the mean difference between ApneaLinkTM AHI autoscore and PSG was 2.75 with SD ± 8.80 (β = 0.034), and between ApneaLinkTM AHI revised score and PSG -1.50 with SD ± 9.28 (β = 0.060).

Conclusions: The ApneaLinkTM autoscore demonstrated good sensitivity and specificity compared with the gold standard (full-night attended PSG). However, Bland Altman plots revealed substantial fluctuations between PSG and ApneaLinkTM AHI autoscore respectively manually revised score. This spread for the AHI from a clinical perspective is large, and therefore the results have to be interpreted with caution. Furthermore, our findings suggest that there is no clinical benefit in manually revising the ApneaLinkTM autoscore.

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Conflict of interest statement

DM is an employee of the funding organization (SUVA). Beside his work as a consultant at SUVA, he is involved in independent research projects at the University of Basel and the Cantonal Hospital Baselland Liestal. The funder (SUVA) did not have any role in the study design, data collection and analysis, decision to publish, or preparation of this manuscript. Furthermore, this does not alter our adherence to PLOS ONE policies on sharing data and materials. The other authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow of study participants.
OI, occupational injury; w/o, without; PSG, polysomnography.
Fig 2
Fig 2. Bland-Altman plot illustrating the difference in AHI as measured from ApneaLinkTM autoscore versus PSG.
Plots present differences between the two methods compared to mean AHI of the two methods. The black solid line represents the mean difference, the black thin lines the 95% confidence intervals on the limits of agreement. ALA, ApneaLinkTM autoscore; PSG, polysomnography.
Fig 3
Fig 3. Bland-Altman plot illustrating the difference in AHI as measured from ApneaLinkTM manually revised versus PSG.
Plots present differences between the two methods compared to mean AHI of the two methods. The black solid line represents the mean difference, the black thin lines the 95% confidence intervals on the limits of agreement. ALM, ApneaLinkTM manually revised; PSG, polysomnography.
Fig 4
Fig 4. Distribution of patients with and without an OI across AHI categories based on ApneaLinkTM autoscore.
OI, occupational injury; AHI, apnea-hypopnea index; CI, confidence interval.
Fig 5
Fig 5. Distribution of patients with and without an OI across AHI categories based on manually revised ApneaLinkTM score.
OI, occupational injury; w/o, without; AHI, apnea-hypopnea index; CI, confidence interval.
See this image and copyright information in PMC

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