Principles and Practice of Sleep Medicine

Obstructive sleep apnea (OSA) may lead to life-threatening problems if it is left undiagnosed. Polysomnography is the “gold standard” for OSA diagnosis; however, it is expensive and not widely available. The objective of this systematic review is to identify and evaluate the available questionnaires for screening OSA. We carried out a literature search through MEDLINE, EMBASE, and CINAHL to identify eligible studies. The methodological validity of each study was assessed using the Cochrane Methods Group’s guideline. Ten studies (n = 1,484 patients) met the inclusion criteria. The Berlin questionnaire was the most common questionnaire (four studies) followed by the Wisconsin sleep questionnaire (two studies). Four studies were conducted exclusively on “sleep-disorder patients”, and six studies were conducted on “patients without history of sleep disorders”. For the first group, pooled sensitivity was 72.0% (95% confidence interval [CI]: 66.0-78.0%; I2 = 23.0%) and pooled specificity was 61.0% (95% CI: 55.0-67.0%; I2 = 43.8%). For the second group, pooled sensitivity was 77.0% (95% CI: 73.0-80.0%; I2 = 78.1%) and pooled specificity was 53.0% (95% CI: 50-57%; I2 = 88.8%). The risk of verification bias could not be eliminated in eight studies due to insufficient reporting. Studies on snoring, tiredness, observed apnea, and high blood pressure (STOP) and STOP including body mass index, age, neck circumference, gender (Bang) questionnaires had the highest methodological quality. The existing evidence regarding the accuracy of OSA questionnaires is associated with promising but inconsistent results. This inconsistency could be due to studies with heterogeneous design (population, questionnaire type, validity). STOP and STOP-Bang questionnaires for screening of OSA in the surgical population are suggested due to their higher methodological quality and easy-to-use features.

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A systematic review of screening questionnaires for obstructive sleep apnea.

Purpose Obstructive sleep apnea (OSA) may lead to lifethreatening problems if it is left undiagnosed. Polysomnography is the ‘‘gold standard’’ for OSA diagnosis; however, it is expensive and not widely available. The objective of this systematic review is to identify and evaluate the available questionnaires for screening OSA. Source We carried out a literature search through MEDLINE, EMBASE, and CINAHL to identify eligible studies. The methodological validity of each study was assessed using the Cochrane Methods Group’s guideline. Principal findings Ten studies (n = 1,484 patients) met the inclusion criteria. The Berlin questionnaire was the most common questionnaire (four studies) followed by the Wisconsin sleep questionnaire (two studies). Four studies were conducted exclusively on ‘‘sleep-disorder patients’’, and six studies were conducted on ‘‘patients without history of sleep disorders’’. For the first group, pooled sensitivity was 72.0% (95% confidence interval [CI]: 66.0-78.0%; I 2 = 23.0%) and pooled specificity was 61.0% (95% CI: 55.0-67.0%; I 2 = 43.8%). For the second group, pooled sensitivity was 77.0% (95% CI: 73.0-80.0%; I 2 = 78.1%) and pooled specificity was 53.0% (95% CI: 50-57%; I 2 = 88.8%). The risk of verification bias could not be eliminated in eight studies due to insufficient reporting. Studies on snoring, tiredness, observed apnea, and high blood pressure (STOP) and STOP including body mass index, age, neck circumference, gender (Bang) questionnaires had the highest methodological quality. Conclusion The existing evidence regarding the accuracy of OSA questionnaires is associated with promising but inconsistent results. This inconsistency could be due to studies with heterogeneous design (population, questionnaire type, validity). STOP and STOP-Bang questionnaires for screening of OSA in the surgical population are suggested due to their higher methodological quality and easy

A systematic review of screening questionnaires for obstructive sleep apnea Une revue methodique des questionnaires de depistage de l'apnee obstructive du sommeil

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60176-1.pdf

Sudden unexpected death in epilepsy

Results. Thirteen studies were included in the final analysis (n¼3942). OSA was associated with significantly higher odds of any postoperative cardiac events [45/1195 (3.76%) vs 24/1420 (1.69%); odds ratio (OR) 2.07; 95% confidence interval (CI) 1.23‐3.50, P¼0.007] and ARF [33/ 1680 (1.96%) vs 24/3421 (0.70%); OR 2.43, 95% CI 1.34‐4.39, P¼0.003]. Effects were not heterogeneous for these outcomes (I 2 ¼0‐15%, P.0.3). OSA was also significantly associated with higher odds of desaturation [189/1764 (10.71%) vs 105/1881 (5.58%); OR 2.27, 95% CI 1.20‐4.26, P¼0.01] and ICU transfer [105/2062 (5.09%) vs 58/3681 (1.57%), respectively; OR 2.81, 95% CI 1.46‐5.43, P¼0.002]. Both outcomes showed a significant degree of heterogeneity of the effect among studies (I 2 ¼57‐68%, P,0.02). Subgroup analyses had similar conclusions as main analyses. Conclusions. The incidence of postoperative desaturation, respiratory failure, postoperative

Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome

Background: Previous reports have documented the coexistence of obstructive sleep apnea (OSA) and epilepsy and the therapeutic effects of treatment on seizure frequency and daytime sleepiness. The authors’ objective was to determine the prevalence of OSA and its association with survey items in a group of patients with medically refractory epilepsy undergoing polysomnography (PSG). Methods: Thirty-nine candidates for epilepsy surgery without a history of OSA underwent PSG as part of a research protocol examining the relationship of interictal epileptiform discharges to sleep state. Subjects also completed questionnaires about their sleep, including validated measures of sleep-related breathing disorders (Sleep Apnea Scale of the Sleep Disorders Questionnaire [SA/SDQ]) and subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]). Results: One-third of subjects had OSA, defined by a respiratory disturbance index (RDI) ≥ 5. Five subjects (13%) had moderate to severe OSA (RDI > 20). Subjects with OSA were more likely to be older, male, have a higher SA/SDQ score, and more likely to have seizures during sleep than those without OSA (p Conclusions: In our sample, previously undiagnosed obstructive sleep apnea was common, especially among men, older subjects, and those with seizures during sleep. The impact of treating OSA on seizure frequency and daytime sleepiness in medically refractory epilepsy patients warrants further controlled study.

Kirk Levy

Papers

Obstructive sleep apnea is common in medically refractory epilepsy patients