[Diagnostic utility of screening tools (Epworth scale, Berlin questionnaire, and STOP-Bang questionnaire) in moderate-to-severe obstructive sleep apnea supported by simple home-based diagnostic methods in primary care].

OBJECTIVES

To assess the usefulness of the Epworth (ESS), Berlin, and STOP-Bang (SB) screening tools, combined with the Apnealink™ device (AL), in collaboration with the USH, in diagnosing OSA with AHI≥5/h or moderate-to-severe OSA (IAH≥15/h).

MATERIAL AND

METHODS

The study included patients aged 18 to 80years with suspected OSA and a SB score ≥3. Patients were initially assessed by a primary care physician (PCP) using the AL device and subsequently evaluated by the USH. Collected data included anthropometric measurements, personal medical history, clinical characteristics related to OSA, screening tool scores, AL study results, PGR findings, diagnostic and therapeutic decisions made by the PCP, and confirmatory assessments by the USH. All data were entered into a computerized system for statistical analysis. The study analyzed both the overall sample and gender-specific subgroups. The effectiveness of the screening tools was assessed through ROC curve analysis.

RESULTS

The study included 150 patients (97men, 53women) with a mean age of 56±12.37years. Significant gender differences were observed: men had higher values for weight, height, BMI≥35, neck circumference, waist circumference, waist-to-hip ratio, elevated neck circumference (>43cm in men, >41cm in women), high SB score (≥5), and higher tobacco and alcohol consumption. A total of 144 patients underwent AL testing, with 133 patients having an AHI>5/h and 98 patients an AHI≥15/h. The agreement with the USH was 89%, with a K=0.88±0.036 (95%CI: 0.8-0.94, P<.001). According to the screening tools, the probability of having OSA with AHI≥5/h was: SB-AUC=0.63±0.08 (95%CI: 0.047-0.78, P=.098). For AHI≥15/h: SB-AUC=0.77±0.04 (95%CI: 0.048-0.92, P=0.080), Berlin-AUC=0.55±0.05 (95%CI: 0.45-0.66, P=.305), ESS-AUC=0.49±0.05 (95%CI: 0.039-0.59, P=.889).

CONCLUSIONS

The SB tool demonstrated the best performance. The use of screening tools combined with simple diagnostic methods in primary care, in collaboration with USH, is both feasible and cost-effective for managing OSA in our setting.