Sleep Articles

General Practice Sleep Scale – The “GPSS” – A proposed new tool for use in General Practice for risk assessment of Obstructive Sleep Apnoea

Timothy Howarth a,b, Joe Hedger c, Winnie Chen c,d,e, Himanshu Garg f, Subash S. Heraganahally a,f,g,*,

Abstract:

Background: This pilot study investigated a new simplified OSA screening tool that could be used in primary care/GP settings – the “GPSS” tool – “General Practice Sleep Scale” and compared against common existing OSA screening tools. Methods: A convenience sample of patients attending the respiratory and sleep clinic in the Northern Territory of Australia were included if they completed the GPSS prior to undergoing a diagnostic polysomnography. The GPSS contained 9 questions to provide information on: sex, age, body mass index, neck circumference, snoring, witnessed apnoeas, morning tiredness, daytime sleepiness and presence of hypertension/diabetes/heart disease/ depression. Presence of OSA was defined as an apnoea-hypopnoea index of ≥15/hour. The GPSS scoring was developed via log odds of regression predictions for each GPSS question upon OSA.

Results:

159 patients (65 % male, median age 45 years) were enrolled. A minimum score of 1 was assigned to GPSS questions, up to 5 for the strongest predictor (neck circumference). The median total GPSS score was 13 (IQR 9, 16) (maximum 22) and correlated strongly with OSA (AUC 0.812 (95 % CI 0.744, 0.881)). Categorised into low (0–7), moderate (8–13) or high risk (>13), a moderate or severe score had sensitivity 100, specificity 34.9 %. The GPSS significantly outperformed the Epworth Sleepiness Scale, Berlin questionnaire and OSA-50, and was comparable but slightly improved against the STOP-Bang. Conclusions: The proposed GPSS tool could be of use in general practice settings. Further prospective research is warranted to test the applicability and adaptability of the GPSS tool in wider population settings.

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Does AHI Value Enough for Evaluating the Obstructive Sleep Apnea Severity?

Yusuf Dundar • Guleser Saylam • Emel C¸ adallı Tatar • Ali Ozdek • Hakan Korkmaz • Hikmet Fırat • Sadık Ardıc
Received: 5 March 2014 / Accepted: 5 April 2014 / Published online: 19 April 2014 Association of Otolaryngologists of India 2014

Abstract:

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is an important and more common public health problem with increasing incidence. Polysomonography (PSG) is the gold standard test in OSAHS diagnosis. Apnea-hypopnea index (AHI) is the main parameter of PSG, which is correlated with OSAHS severity. The main complaint of OSAHS patients is daytime sleepiness and the Epworth Sleepiness Scale (ESS) used for evaluation of disease severity. The correlation of AHI with daytime sleepiness and ESS is well known. But there are many patients, which have uncorrelated daytime sleepiness with AHI. This data calls this hypothesis; Are there any other parameters which may affect daytime sleepiness. 648 patients with complaining of snoring and apnea were evaluated by polysomnography and anthropometric measurements. The cut-off value of ESS was accepted 10 as an indicator of severe daytime sleepiness. Patients were divided to groups with the aim of homogenization, according to AHI values. The patients with similar AHI values were analyzed according to their ESS scores. BMI and neck circumference were elevated in daytime sleepiness patients. The nocturnal hypoxemia markers; apnea number/index, maximum duration of apnea, at least SO2 concentration, duration of SO2 less than 90 % were much effected in the group of daytime sleepiness. Beside the fact that our research, AHI is not enough for predicting the daytime sleepiness; anthropometric measurements and the nocturnal hypoxemia markers should be evaluated.

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Continuous Positive Airway Pressure Treatment can Unmask Periodic Limb Movements in Patients with Obstructive Sleep Apnea

Simone Barreto, Rogerio Santos-Silva* and Sergio Tufik and Lia Bittencourt Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo – UNIFESP, Brazi

Abstract:

To test the hypothesis that obstructive sleep apnea (OSA) can mask concurrent periodic limb movements during sleep (PLMS), which becomes evident or worsens after treatment with continuous positive airway pressure (CPAP), the present study investigated the frequency of PLMS during polysomnography (PSG) for OSA diagnoses and for CPAP titration in consecutive patients with OSA. A total of 142 consecutive patients (29 women and 113 men; mean age of 53±10 years; body mass index of 31±6 kg/m2 ) referred to PSG for OSA diagnostic (PSG1) and CPAP titration (PSG2) on two different nights were retrospectively evaluated. The frequency of patients with PLMS index>5 events per hour of sleep was 13 (9%) in PSG1 and 18 (13%) in PSG2. Only four patients had PLMS index>5 in both PSGs. A decrease of the PLMS index was observed in two of the four patients who sustained PLMS index>5 in PSG2 compared to PSG1. These findings showed that the CPAP treatment can unmask but not exacerbate PLMS in patients with OSA.

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