Identifying obstructive sleep apnea in patients with epilepsy: A cross-sectional multicenter study

Area of Science:

• Neurology
• Sleep Medicine
• Medical Diagnostics

Background:

• Obstructive sleep apnea (OSA) is a common comorbidity in epilepsy.
• Several screening questionnaires exist for OSA, but their comparative performance in epilepsy patients is not well-established.
• Accurate OSA screening is crucial for managing epilepsy and its associated risks.

Purpose of the Study:

• To compare the performance of four common screening questionnaires for obstructive sleep apnea (OSA) in adult patients with epilepsy.
• To evaluate the diagnostic accuracy of STOP-BANG, STOP-BAG, SA-SDQ, and NoSAS questionnaires in this specific patient population.

Main Methods:

• A cross-sectional multicenter study involving 166 adult epilepsy patients in Thailand.
• Participants completed STOP-BANG, STOP-BAG, SA-SDQ, and NoSAS questionnaires prior to polysomnography (PSG).
• Obstructive sleep apnea (OSA) was defined by apnea/hypopnea index (AHI) criteria (≥5, ≥15, ≥30); discriminatory ability was assessed using ROC curves and likelihood ratios.

Main Results:

• OSA prevalence was 38% among the epilepsy patients.
• The NoSAS questionnaire showed higher area under the curve (AUC) values across all AHI criteria compared to other scales, though not always statistically significant.
• Using NoSAS with cut-points of ≥4 and ≥8 to predict OSA (AHI ≥5) yielded likelihood ratios of 0.37, 2.22, and 9.81 for different risk ranges.

Conclusions:

• The NoSAS questionnaire, particularly with a two-cut-point scoring system, exhibited the highest discriminatory ability for detecting obstructive sleep apnea (OSA) in patients with epilepsy.
• This finding suggests NoSAS is a valuable tool for screening OSA in this population.