Improving OSA screening efficiency with subjective questionnaires: integrating STOP-Bang, ESS, and Berlin

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Diagnostic Accuracy

Background:

• Obstructive sleep apnea (OSA) is a prevalent condition requiring effective screening tools.
• Current screening methods like the STOP-Bang, Epworth Sleepiness Scale (ESS), and Berlin questionnaire have varying predictive values.
• Optimizing screening strategies is crucial for timely OSA diagnosis and management.

Purpose of the Study:

• To compare the predictive accuracy of individual screening questionnaires for obstructive sleep apnea (OSA).
• To evaluate the effectiveness of combining these questionnaires in a multi-step screening approach.
• To determine an optimal strategy for improving OSA screening efficiency.

Main Methods:

• A cohort of 2,208 suspected OSA patients completed the ESS, STOP-Bang, and Berlin questionnaires.
• Polysomnography (PSG) was used as the gold standard for OSA diagnosis.
• Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curves were analyzed for individual and combined questionnaires.

Main Results:

• The Berlin questionnaire demonstrated the highest Area Under the Curve (AUC) and PPV among individual scales.
• STOP-Bang offered the highest sensitivity and NPV, while ESS showed the highest specificity.
• Combining questionnaires generally decreased AUC, but the three-scale combination yielded the highest specificity and PPV, albeit with reduced sensitivity and NPV.

Conclusions:

• Increasing the number of screening tools improves specificity and PPV but decreases sensitivity and NPV.
• A recommended three-step screening strategy involves a STOP-Bang score of 3, an ESS score of 9, and the Berlin questionnaire.
• This combined approach aims to enhance the specificity and PPV for obstructive sleep apnea screening.