TY - JOUR
T1 - Development and validation of a model for diagnosis of obstructive sleep apnoea in primary care
AU - Chapman, Julia L.
AU - Hoyos, Camilla M.
AU - Killick, Roo
AU - Sutherland, Kate
AU - Cistulli, Peter A.
AU - Zwar, Nick
AU - Yee, Brendon J.
AU - Marks, Guy
AU - Grunstein, Ronald R.
AU - Wong, Keith K.H.
AU - The Sydney OSA-GP study Investigators
AU - Siebers, Amanda
AU - Dungan, George
AU - Dennis, Sarah
AU - Rofail, Lydia Makarie
AU - Vedam, Hima
AU - Buchanan, Peter
AU - Harrington, Zinta
AU - Lee, Richard
AU - Chan, Andrew S. L.
AU - Williams, Mark
AU - Ng, Andrew
AU - Wong, Eric
AU - Jones, Michael
PY - 2021/10
Y1 - 2021/10
N2 - BACKGROUND AND OBJECTIVE: Use of in-laboratory polysomnography (PSG) to diagnose obstructive sleep apnoea (OSA) is cost and resource intensive. Questionnaires, physical measurements and home monitors have been studied as potential simpler alternatives. This study aimed to develop a diagnostic model for OSA for use in primary care.METHODS: Primary care practitioners were trained to recognize symptoms of sleep apnoea and recruited patients based on the clinical need to investigate OSA. Assessment was by symptom questionnaires, anthropomorphic measurements, digital facial photography, and a single-channel nasal flow monitor (Flow Wizard©, DiagnoseIT, Sydney, Australia) worn at home for 3 nights. The in-laboratory PSG was the reference test, with OSA defined as apnoea-hypopnoea index (AHI) ≥10 events/h.RESULTS: In the model development phase, 25 primary care practitioners studied 315 patients in whom they suspected OSA, of which 57% had AHI≥10 and 22% had AHI≥30. Published OSA questionnaires provided low to moderate prediction of OSA (area under the curve [AUC] 0.53-0.73). The nasal flow monitor alone yielded high accuracy for predicting OSA with AUC of 0.87. Sensitivity was 0.87 and specificity 0.77 at a threshold respiratory event index (REI) of 18 events/h. A model adding age, gender, symptoms and BMI to the nasal flow monitor REI only modestly improved OSA prediction (AUC 0.89), with similar AUC (0.88) confirmed in the validation population of 114 patients.CONCLUSION: Sleep apnoea can be diagnosed in the primary care setting with a combination of clinical judgement and portable monitor test outcomes.
AB - BACKGROUND AND OBJECTIVE: Use of in-laboratory polysomnography (PSG) to diagnose obstructive sleep apnoea (OSA) is cost and resource intensive. Questionnaires, physical measurements and home monitors have been studied as potential simpler alternatives. This study aimed to develop a diagnostic model for OSA for use in primary care.METHODS: Primary care practitioners were trained to recognize symptoms of sleep apnoea and recruited patients based on the clinical need to investigate OSA. Assessment was by symptom questionnaires, anthropomorphic measurements, digital facial photography, and a single-channel nasal flow monitor (Flow Wizard©, DiagnoseIT, Sydney, Australia) worn at home for 3 nights. The in-laboratory PSG was the reference test, with OSA defined as apnoea-hypopnoea index (AHI) ≥10 events/h.RESULTS: In the model development phase, 25 primary care practitioners studied 315 patients in whom they suspected OSA, of which 57% had AHI≥10 and 22% had AHI≥30. Published OSA questionnaires provided low to moderate prediction of OSA (area under the curve [AUC] 0.53-0.73). The nasal flow monitor alone yielded high accuracy for predicting OSA with AUC of 0.87. Sensitivity was 0.87 and specificity 0.77 at a threshold respiratory event index (REI) of 18 events/h. A model adding age, gender, symptoms and BMI to the nasal flow monitor REI only modestly improved OSA prediction (AUC 0.89), with similar AUC (0.88) confirmed in the validation population of 114 patients.CONCLUSION: Sleep apnoea can be diagnosed in the primary care setting with a combination of clinical judgement and portable monitor test outcomes.
KW - development and validation
KW - diagnostic model
KW - obstructive sleep apnoea
KW - predictive value
KW - primary care
UR - http://www.scopus.com/inward/record.url?scp=85111966732&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/nhmrc/512497
U2 - 10.1111/resp.14122
DO - 10.1111/resp.14122
M3 - Article
C2 - 34342088
AN - SCOPUS:85111966732
SN - 1323-7799
VL - 26
SP - 989
EP - 996
JO - Respirology
JF - Respirology
IS - 10
ER -