Performance of obstructive sleep apnea screening questionnaires in hospitalized patients with heart failure

Prevalence of obstructive sleep apnea (OSA) in patients with heart failure (HF) is estimated at 40-50%. Screening questionnaires such as the STOP-BANG, Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS) have guided clinical decision making in the general population. Performance of these screening tools in hospitalized patients with HF is not known.

Hospitalized patients with HF who were not already diagnosed with OSA underwent inpatient sleep testing and completed questionnaires, during the admissions. Performance of the Berlin Questionnaire (BQ), The Epworth Sleepiness Scale (ESS), and the STOP-BAG questionnaire was measured against the inpatient cardiorespiratory test as the reference standard.

A total of 358 hospitalized HF patients completed all questionnaires and sleep testing. Among them, 215 were diagnosed with OSA. For the prediction of OSA, a model that used weight, age, sex, and cardiovascular parameters including atrial fibrillation, hypertension, left-ventricular dimension, and ejection fraction performed moderately (AUC: 0.688 (95% CI 0.617-0.759)). The addition of any or all of the commonly used questionnaires (STOP-BAG, the BQ, or the ESS) to any demographic or cardiovascular parameters-based model could not exceed the performance of the combined demographic and cardiovascular parameter model in predicting OSA.

OSA screening instruments including STOP-BAG, BQ, and ESS may perform adequately in the general population, but they demonstrated poor performance for predicting OSA in hospitalized HF patients. An approach to surveillance for SDB in hospitalized patients with HF should not rely solely on symptoms-based screening instruments.