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. 2022 Jan 15;22(1):38.
doi: 10.1186/s12890-022-01827-0.

A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study

Patricia Peñacoba  1   2 , Maria Antònia Llauger  3   4 , Ana María Fortuna  5   3 , Xavier Flor  3   6 , Gabriel Sampol  3   7   8 , Anna Maria Pedro-Pijoan  9 , Núria Grau  8   10 , Carme Santiveri  11 , Joan Juvanteny  3   12 , José Ignacio Aoiz  13 , Joan Bayó  13 , Patricia Lloberes  7   8 , Mercè Mayos  5   3   8 ; PASHOS Working Group
Collaborators, Affiliations

A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study

Patricia Peñacoba et al. BMC Pulm Med. .

Abstract

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: 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: 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: 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.

Keywords: Continuous positive airway pressure (CPAP); Home sleep apnea test; Obstructive sleep apnea; Primary healthcare; Screening model; Sleep unit.

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Conflict of interest statement

The first author and none of the other authors have any affiliations or financial involvement that conflict with the material presented in this study.

Figures

Fig. 1
Fig. 1
Flow chart of the study population (OSA: obstructive sleep apnea; HSAT: home sleep apnea test; RP: respiratory polygraphy; PSG; polysomnography)
Fig. 2
Fig. 2
Diagnostic accuracy of the PASHOS Test for a cut-off value of ≥ 5 and different study questionnaires (left panel) as well as variables obtained with the home sleep apnea test (right panel) (AUC: area under the ROC curve; CI: confidence interval; AHI: apnea–hypopnea index; ODI3%: oxygen desaturation index of 3%; ODI4%: oxygen desaturation index of 4%)
See this image and copyright information in PMC

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