Predicting Obstructive Sleep Apnea in Patients with Insomnia: A Comparative Study with Four Screening Instruments

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Diagnostic Tools

Background:

• Obstructive sleep apnea (OSA) and insomnia are highly prevalent, with insomnia often presenting as the primary complaint for OSA.
• Effective screening tools are crucial for identifying OSA in patients presenting with insomnia symptoms.

Purpose of the Study:

• To validate the No-Apnea screening tool for obstructive sleep apnea (OSA) in patients reporting insomnia.
• To compare the performance of No-Apnea against other established screening models like STOP-Bang, NoSAS, and the Epworth Sleepiness Scale (ESS).

Main Methods:

• A cross-sectional study evaluated No-Apnea, STOP-Bang, NoSAS, and ESS in 2591 patients with insomnia undergoing polysomnography.
• Discrimination was assessed using the area under the curve (AUC), with OSA severity categorized by the apnea/hypopnea index (≥5, ≥15, ≥30 events/h).

Main Results:

• No-Apnea demonstrated high sensitivity (84.5-94.1%) and moderate specificity (35.1-58.2%) across all OSA severity levels.
• The discriminatory ability (AUC) for No-Apnea ranged from 0.753 to 0.790.
• No-Apnea, STOP-Bang, and NoSAS showed comparable and satisfactory discrimination for OSA screening, while ESS performed poorly.

Conclusions:

• No-Apnea, STOP-Bang, and NoSAS are validated as effective screening tools for obstructive sleep apnea (OSA) in individuals with insomnia complaints.
• These tools provide satisfactory and similar discriminatory performance across all OSA severity levels.
• The Epworth Sleepiness Scale (ESS) is not recommended as a primary screening tool for OSA in this patient population.