Comparison of commonly used screening tools for determining obstructive sleep apnea amongst aviation employees

Epidemiological evidence suggests the prevalence of Obstructive Sleep Apnea (OSA) ranges 9-38%. Multiple screening tools are used to aid diagnosis. In professions that require high levels of attentiveness, safety, and responsibility for other's lives, inaccuracies and biases are probable for self-reported data. We sought to assess the best screening tool for OSA amongst aircraft pilots and air traffic controllers (ATCs).

Data were collected as part of routine clinical care for patients presenting to Sleep Disorders Specialized Clinic. A total 1384 patients attended the clinic (2012-2018), of which 254 were either pilots or ATCs. Patients responded to three questionnaires, regularly used for OSA screening: 1) Epworth Sleepiness Scale (ESS); 2) Berlin Questionnaire (BQ); 3) STOP-BANG Questionnaire (SBQ). We used non-parametric ROC analysis, sensitivity, and specificity measures, along with positive and negative predictive values (PPV/NPV) to determine the most accurate diagnostic instrument.

The ROC (95% CI) for the ESS, BQ, and SBQ was 0.49 (0.39-0.59), 0.58 (0.49-0.67), and 0.56 (0.47-0.65), respectively. When the SBQ was used in combination with the ESS, the sensitivity was high at 100% (78.2-100.0), as were the PPV and NPV, 83.3% (58.6-96.4) and 100.0 (2.5-100.0), respectively.

The SBQ, in combination with the ESS, was the most reliable diagnostic tool for OSA in pilots and ATCs. Physicians should prioritize use of these screening tools for predicting OSA when assessing those working in the aviation industry and similar occupational groups, such as drivers. Given the scarcity of literature in this population, we recommend future studies replicate ours to either confirm or refute the findings.