Performance of Four Screening Tools for Identifying Obstructive Sleep Apnea Among Patients with Insomnia

Area of Science:

• Sleep Medicine
• Diagnostic Tools
• Clinical Research

Background:

• Co-morbid insomnia and obstructive sleep apnea (OSA) are prevalent in clinical settings.
• Existing OSA screening tools lack validation in insomnia populations, potentially affecting accuracy due to daytime function assessments.

Purpose of the Study:

• To validate the performance of four common OSA screening tools (STOP-Bang, Epworth Sleepiness Scale, Berlin questionnaire, NoSAS) in individuals with and without insomnia.
• To assess the impact of insomnia on the diagnostic accuracy of these screening tools.

Main Methods:

• A cross-sectional survey of 1266 participants suspected of OSA undergoing sleep studies.
• Participants completed the Insomnia Severity Index (ISI), STOP-Bang, ESS, Berlin, and NoSAS questionnaires.
• Clinical insomnia was defined as an ISI score ≥15. Performance was evaluated using sensitivity, specificity, and ROC curves.

Main Results:

• In the presence of insomnia, STOP-Bang, ESS, and Berlin showed increased sensitivity but decreased specificity for detecting OSA (apnea-hypopnea index ≥15/h).
• STOP-Bang achieved the highest sensitivity (93.2%) at conventional cutoffs, while NoSAS had the highest specificity (67.7%).
• STOP-Bang and NoSAS demonstrated superior performance (ROC AUC >0.7) compared to ESS and Berlin across all OSA severity levels.

Conclusions:

• Insomnia alters the performance of OSA screening tools that assess daytime function.
• STOP-Bang is identified as the preferred screening tool due to its high sensitivity in patients with co-morbid insomnia and OSA when using conventional cutoffs.