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Title Low Reliability Of The Self-Assessment Of Obstructive Sleep Apnea Using Questionnaires
Clinical Question How does the self-assessment of obstructive sleep apnea symptoms by an adult patient through questionnaires correlate in specificity and sensitivity to home sleep recording and/or lab sleep recording?
Clinical Bottom Line A number of different types of questionnaires for screening and diagnosis of obstructive sleep apnea (OSA) are documented since the late ‘80s. A diagnosis of OSA based solely on questionnaires can not be recommended due to the low specificity and sensitivity of this diagnostic tool. A polysomnographic analysis is still to be regarded as the gold standard for diagnostics of OSA.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20143278Abrishami/20101,484 patientsSystematic Review
Key resultsIn the 10 studies fulfilling the inclusion criteria (total: 1,484 patients), the questionnaires used for the assessment of OSA are promising but evidence on their accuracy is still scarce. The pooled sensitivity of questionnaires for studies conducted on patients without a history of OSA was 77% (95% CI: 73 - 80%) and the pooled specificity was 53% (95% CI: 50 - 57%). Heterogeneous questionnaire types and methodologies are recognized as a major challenge in comparative analyses.
#2) 22152589Sil/2012109 OSA patients & 238 healthy controlsReview + Retrospective Record Review
Key resultsSixteen studies analyzing the correlation between the questionnaire-based Epworth Score and OSA were found. Five studies found a weak but significant correlation, 11 didn’t. No meta-analysis was performed because of heterogeneity. Among the 105 OSA-diagnosed and 238 healthy individuals included in the retrospective analysis, the mean Epworth score for patients with OSA was 10.94 (95% CI: 9.46 - 11.42) and 7.73% (95% CI: 7.04 - 8.41) for the non-OSA patients. The odds ratio for Epworth scoring was 1.118, and only 69% of the cases were correctly classified by the Epworth scoring, thus classifying the predictive potential of this Scale as marginal.
Evidence Search "Sleep Apnea, Obstructive/diagnosis"[Majr] Filters: Review AND "Questionnaires/standards"[Majr] Filters: Review
Comments on
The Evidence
The methods in the systematic review by Abrishami et. al., 2010 are well-described. In the study by Sil & Barr 2012, details about the methods used for the literature search and for the subsequent statistical analysis are missing. Lists of the 16 studies found and of the patient numbers considered are not available. It is remarkable, that only one out of 16 studies matches with the search results of the paper by Abrishami et. al., 2010.
Applicability Questionnaire-based methods, including the Epworth scoring, the Berlin and the Wisconsin sleep questionnaire, are used as a screening method for OSA in many ENT centers. The evidence suggests that they should not be used alone for purpose of screening or diagnosis of OSA. Patients with an history suggesting OSA (excessive sleepiness, snoring, witnessed apnea episodes) should undergo a sleep assessment independently from available questionnaire scores. Due to the high costs of a laboratory polysomnographic assessment (the gold-standard for the diagnosis of OSA), a stepwise diagnostic approach using questionnaires, patient’s history, simple sleep monitoring (e.g. pulse-oxymetric) and finally polysomnography is recommended.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Orthodontics) (Dental Hygiene)
Keywords Sleep apnea, diagnosis, questionnaire, self-assessment.
ID# 2346
Date of submission: 02/18/2013spacer
E-mail janner@uthscsa.edu
Author Simone Janner
Co-author(s) Thomas Girvan
Co-author(s) e-mail Thomas.Girvan@va.gov
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