Screening for obstructive sleep apnea in veterans with ischemic heart disease using a computer-based clinical...

Area of Science:

• Cardiology
• Sleep Medicine
• Medical Technology

Background:

• Obstructive sleep apnea (OSA) is prevalent in veterans with ischemic heart disease.
• Early detection and management of OSA are crucial for cardiovascular health.
• Current screening methods may have limitations in this specific population.

Purpose of the Study:

• To evaluate the diagnostic accuracy of a handheld clinical decision-support system (CDSS) for detecting OSA in veterans with ischemic heart disease.
• To compare the performance of the CDSS against polysomnography (PSG), the gold standard for OSA diagnosis.
• To assess the diagnostic accuracy of the CDSS relative to the Berlin questionnaire.

Main Methods:

• Prospective enrollment of 143 veterans with ischemic heart disease.
• Exclusion of participants with specific comorbidities (neurologic disease, heart failure, opiate use).
• Administration of the Berlin questionnaire and the CDSS, followed by in-laboratory polysomnography (PSG).

Main Results:

• Out of 91 completers, OSA prevalence was 74.7% (median AHI 11.5/h).
• The CDSS achieved 98.5% sensitivity and 86.9% specificity for OSA (AHI ≥5/h).
• The Berlin questionnaire showed 80.9% sensitivity and 39.1% specificity; CDSS outperformed BQ (AUC 0.93 vs 0.60).

Conclusions:

• The handheld CDSS is a highly sensitive and specific tool for screening OSA in veterans with ischemic heart disease.
• The CDSS significantly outperforms the Berlin questionnaire in identifying undiagnosed OSA in this patient group.
• CDSS offers a promising, accurate, and potentially more efficient screening method for OSA in cardiac veterans.