Cited by 297Obstructive Sleep Apnea ResearchAirway Management and Intubation TechniquesSleep and related disorders

The DOI matches its Crossref record; 57 of the 57 references it cites were found in a registry or an index.

A Meta-analysis of Clinical Screening Tests for Obstructive Sleep Apnea

Open access

Ramachandran, Satya Krishna, Josephs, Lydia A.·2009·Anesthesiology

Open this paper in CoChat — free account Open PDF

Abstract

The purpose of this meta-analysis is to compare clinical screening tests for obstructive sleep apnea and establish an evidence base for their preoperative use. Diagnostic odds ratios were used as summary measures of accuracy, and false-negative rates were used as measures of missed diagnosis with each screening test in this review. Metaregression revealed that clinical models, logarithmic equations, combined techniques, cephalometry, and morphometry are significant characteristics, whereas body mass index, history of hypertension, and nocturnal choking are significant test elements associated with higher diagnostic accuracy. Test accuracy in repeated validation studies of the same screening test is variable, suggesting an underlying heterogeneity in either the clinical presentation of obstructive sleep apnea or the measured clinical elements of these models. Based on the false-negative rates, it is likely that most of the clinical screening tests will miss a significant proportion of patients with obstructive sleep apnea.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Integrity signals

Registry

Crossref · 10.1097/aln.0b013e31819c47b6

Cites

57 of 57 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139
The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults
Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993) · New England Journal of Medicine · doi:10.1056/nejm199304293281704 · Cited by 10,183
Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension
Peppard, P. E., Young, T., Palta, M., & Skatrud, J. (2000) · New England Journal of Medicine · doi:10.1056/nejm200005113421901 · Cited by 4,973
Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome
Netzer, N. C., Stoohs, R. A., Netzer, C. M., Clark, K., & Strohl, K. P. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-131-7-199910050-00002 · Cited by 2,973
STOP Questionnaire: A Tool to Screen Patients for Obstructive Sleep Apnea
Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., Vairavanathan, S., Islam, S., Khajehdehi, A., & Shapiro, C. M. (2008) · Anesthesiology · doi:10.1097/aln.0b013e31816d83e4 · Cited by 2,355
The diagnostic odds ratio: a single indicator of test performance
Glas, A. S., Lijmer, J. G., Prins, M. H., Bonsel, G. J., & Bossuyt, P. M. M. (2003) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(03)00177-x · Cited by 2,261
Estimation of the Clinically Diagnosed Proportion of Sleep Apnea Syndrome in Middle-aged Men and Women
Young, T., Evans, L., Finn, L., & Palta, M. (1997) · Sleep · doi:10.1093/sleep/20.9.705 · Cited by 1,765
Systematic reviews of evaluations of diagnostic and screening tests
Deeks, J. J. (2001) · BMJ · doi:10.1136/bmj.323.7305.157 · Cited by 1,345
Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea
Gross, J. B., Bachenberg, K. L., Benumof, J. L., Caplan, R. A., Connis, R. T., Coté, C. J., Nickinovich, D. G., Prachand, V. N., Ward, D. S., Weaver, E. M., et al. (2006) · Anesthesiology · doi:10.1097/00000542-200605000-00026 · Cited by 1,182
Daytime Sleepiness, Snoring, and Obstructive Sleep Apnea
Johns, M. W. (1993) · CHEST Journal · doi:10.1378/chest.103.1.30 · Cited by 1,118
Day–Night Pattern of Sudden Death in Obstructive Sleep Apnea
Gami, A. S., Howard, D. E., Olson, E. J., & Somers, V. K. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa041832 · Cited by 1,032
Association of Sleep-disordered Breathing and the Occurrence of Stroke
Arzt, M. E., Young, T. B., Finn, L. A., Skatrud, J. B., & Bradley, T. D. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200505-702oc · Cited by 980
Sources of Variation and Bias in Studies of Diagnostic Accuracy
Whiting, P. F., Rutjes, A. W., Reitsma, J. B., Glas, A. S., Bossuyt, P. M., & Kleijnen, J. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-3-200402030-00010 · Cited by 804
Guidelines for Meta-analyses Evaluating Diagnostic Tests
Irwig, L., Tosteson, A. N. A., Gatsonis, C., Lau, J., Colditz, G. A., Chalmers, T. C., & Mosteller, F. (1994) · Annals of Internal Medicine · doi:10.7326/0003-4819-120-8-199404150-00008 · Cited by 754
Access to Diagnosis and Treatment of Patients with Suspected Sleep Apnea
Flemons, W. W., Douglas, N. J., Kuna, S. T., Rodenstein, D. O., & Wheatley, J. R. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200308-1124pp · Cited by 678
Postoperative Complications in Patients With Obstructive Sleep Apnea Syndrome Undergoing Hip or Knee Replacement: A Case-Control Study
Gupta, R. M., Parvizi, J., Hanssen, A. D., & Gay, P. C. (2001) · Mayo Clinic Proceedings · doi:10.4065/76.9.897 · Cited by 622
Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients
Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., Vairavanathan, S., Islam, S., Khajehdehi, A., & Shapiro, C. M. (2008) · Anesthesiology · doi:10.1097/aln.0b013e31816d91b5 · Cited by 571
The Sleep Disorders Questionnaire I: Creation and Multivariate Structure of SDQ
Douglass, A. B., Bomstein, R., Nino‐Murcia, G., Keenan, S. A., Miles, L. E. M., Zarcone, V. P., Guilleminault, C., & Dement, W. C. (1994) · SLEEP · doi:10.1093/sleep/17.2.160 · Cited by 560
An independent association between obstructive sleep apnoea and coronary artery disease
Peker, Y., Kraiczi, H., Hedner, J. A., Löth, S., Johansson, A., & Bende, M. (1999) · European Respiratory Journal · doi:10.1034/j.1399-3003.1999.14a30.x · Cited by 476
Exploring sources of heterogeneity in systematic reviews of diagnostic tests
Lijmer, J. G., Bossuyt, P. M., & Heisterkamp, S. H. (2002) · Statistics in Medicine · doi:10.1002/sim.1185 · Cited by 446
Estimating Diagnostic Accuracy from Multiple Conflicting Reports
Littenberg, B., & Moses, L. E. (1993) · Medical Decision Making · doi:10.1177/0272989x9301300408 · Cited by 425
A Predictive Morphometric Model for the Obstructive Sleep Apnea Syndrome
Kushida, C. A., Efron, B., & Guilleminault, C. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-127-8_part_1-199710150-00001 · Cited by 341
Spectrum Bias or Spectrum Effect? Subgroup Variation in Diagnostic Test Evaluation
Engel, S. A. M., & Miller, W. C. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-137-7-200210010-00011 · Cited by 331
A Randomized Controlled Trial of Continuous Positive Airway Pressure in Mild Obstructive Sleep Apnea
Barnes, M., Houston, D., Worsnop, C. J., Neill, A. M., Mykytyn, I. J., Kay, A., Trinder, J., Saunders, N. A., McEvoy, R. D., & Pierce, R. J. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.165.6.2003166 · Cited by 329 · cited 1×
“Indeed, regular continuous positive airway pressure therapy for mild OSA (with excessive daytime somnolence) and moderate OSA has not been shown to have the same impact on systemic disease as compared with severe OSA.(27) Further research into defining the subset Fig.”
Background
Are History and Physical Examination a Good Screening Test for Sleep Apnea?
Viner, S., Szalai, J. P., & Hoffstein, V. (1991) · Annals of Internal Medicine · doi:10.7326/0003-4819-115-5-356 · Cited by 292
A proposed architecture and method of operation for improving the protection of privacy and confidentiality in disease registers
Churches, T. (2003) · BMC Medical Research Methodology · doi:10.1186/1471-2288-3-1 · Cited by 241
The Use of Clinical Prediction Formulas in the Evaluation of Obstructive Sleep Apnea
Rowley, J. A., Aboussouan, L. S., & Badr, M. S. (2000) · SLEEP · doi:10.1093/sleep/23.7.929 · Cited by 224
Obstructive Sleep Apnea as a Risk Marker in Coronary Artery Disease
Schäfer, H., Koehler, U., Ewig, S., Hasper, E., Tasci, S., & Lüderitz, B. (1999) · Cardiology · doi:10.1159/000006952 · Cited by 219
Sequential boundaries approach in clinical trials with unequal allocation ratios
Jafari, P., Ayatollahi, S. M. T., & Behboodian, J. (2006) · BMC Medical Research Methodology · doi:10.1186/1471-2288-6-1 · Cited by 217
Predicting Sleep Apnea and Excessive Day Sleepiness in the Severely Obese
Dixon, J. B., Schachter, L. M., & O’Brien, P. E. (2003) · CHEST Journal · doi:10.1378/chest.123.4.1134 · Cited by 212
The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance
Ahmadi, N., Chung, S. A., Gibbs, A. L., & Shapiro, C. M. (2007) · Sleep And Breathing · doi:10.1007/s11325-007-0125-y · Cited by 188
Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome.
Sharma, S. K., Vasudev, C., Sinha, S., Banga, A., Pandey, R. M., & Handa, K. K. (2006) · PubMed · Cited by 185
Pulmonary Hypertension, Hypoxemia, and Hypercapnia in Obstructive Sleep Apnea Patients
Krieger, J., Sforza, E. A., Apprill, M., Lantpert, E., Weitzenblum, E., & Ratomaharv, J. (1989) · CHEST Journal · doi:10.1378/chest.96.4.729 · Cited by 183
A cephalometric comparison of subjects with snoring and obstructive sleep apnoea
Battagel, J. M. (2000) · European Journal of Orthodontics · doi:10.1093/ejo/22.4.353 · Cited by 178
Night-to-Night Variability in Sleep Apnea and Sleep-Related Periodic Leg Movements in the Elderly
Mosko, S. S., Dickel, M. J., & Ashurst, J. T. (1988) · SLEEP · doi:10.1093/sleep/11.4.340 · Cited by 175
The cephalometric morphology of patients with obstructive sleep apnoea (OSA)
Battagel, J. M., & L'Estrange, P. R. (1996) · European Journal of Orthodontics · doi:10.1093/ejo/18.6.557 · Cited by 159
Screening for Sleep Apnea Using Pulse Oximetry and A Clinical Score
Williams, A. J., Yu, G. W., Santiago, S., & Stein, M. (1991) · CHEST Journal · doi:10.1378/chest.100.3.631 · Cited by 155
Relative Validity of Self-Reported Snoring as a Symptom of Sleep Apnea in a Sleep Clinic Population
Bliwise, D. L., Nekich, J. C., & Dement, W. C. (1991) · CHEST Journal · doi:10.1378/chest.99.3.600 · Cited by 139
Cost-Utility of Three Approaches to the Diagnosis of Sleep Apnea: Polysomnography, Home Testing, and Empirical Therapy
Chervin, R. D., Murman, D. L., Malow, B. A., & Totten, V. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-130-6-199903160-00006 · Cited by 138
Occupational Screening for Obstructive Sleep Apnea in Commercial Drivers
Gurubhagavatula, I., Maislin, G., Nkwuo, J. E., & Pack, A. I. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200307-968oc · Cited by 133
Obstructive sleep apnea in epilepsy patients: the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) is a useful screening instrument for obstructive sleep apnea in a disease-specific population
Weatherwax, K. J., Lin, X., Marzec, M. L., & Malow, B. A. (2003) · Sleep Medicine · doi:10.1016/j.sleep.2003.07.004 · Cited by 107
Neural Network Prediction of Obstructive Sleep Apnea From Clinical Criteria
Kirby, S. D., Danter, W. R., George, C. F., Francovic, T., Ferguson, K. A., Eng, P., & Ruby, R. R. F. (1999) · CHEST Journal · doi:10.1378/chest.116.2.409 · Cited by 101
An Algorithm to Stratify Sleep Apnea Risk in a Sleep Disorders Clinic Population
Gurubhagavatula, I., Maislin, G., & Pack, A. I. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.164.10.2103039 · Cited by 84
Factors Related to Sleep Apnea Syndrome in Sleep Clinic Patients
Dealberto, M.-J., Ferber-Viart, C., Garma, L., Lemoine, P., & Alpérovitch, A. (1994) · CHEST Journal · doi:10.1378/chest.105.6.1753 · Cited by 79
The Epworth Sleepiness Scale: can it be used for sleep apnoea screening among snorers?
Osman, E. Z., Osborne, J., Hill, P. D., & Lee, B.-J. (1999) · Clinical Otolaryngology · doi:10.1046/j.1365-2273.1999.00256.x · Cited by 68
Model for investigating snorers with suspected sleep apnoea.
Rauscher, H., Popp, W., & Zwick, H. (1993) · Thorax · doi:10.1136/thx.48.3.275 · Cited by 63
Preliminary Report: Validity of Symptom Analysis and Daytime Polysomnography in Diagnosis of Sleep Apnea
Haraldsson, P.-O., Carenfelt, C., KNUTSSON, E., Persson, H., & Rinder, J. (1992) · SLEEP · doi:10.1093/sleep/15.3.261 · Cited by 61
A Clinical Decision Rule to Prioritize Polysomnography in Patients with Suspected Sleep Apnea
Rodsutti, J., Hensley, M., Thakkinstian, A., D’Este, C. A., & Attia, J. (2004) · SLEEP · doi:10.1093/sleep/27.4.694 · Cited by 55
Predictive Diagnostic Value of Clinical Assessment and Nonlaboratory Monitoring System Recordings in Patients with Symptoms Suggestive of Obstructive Sleep Apnea Syndrome
Schäfer, H., Ewig, S., Hasper, E., & Lüderitz, B. (2009) · Respiration · doi:10.1159/000196670 · Cited by 47
Is venous thromboembolism more frequent in patients with obstructive sleep apnea syndrome?
Ambrosetti, M., Lucioni, A. M., Ageno, W., Conti, S., & Neri, M. (2004) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2004.00913.x · Cited by 38
Portable Monitoring in the Diagnosis of the Obstructive Sleep Apnea Syndrome
Littner, M. R. (2005) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-2005-864200 · Cited by 37
Predictive Value of Kushida Index and Acoustic Pharyngometry for the Evaluation of Upper Airway in Subjects With or Without Obstructive Sleep Apnea
Jung, D. G., Cho, H. Y., Grunstein, R. R., & Yee, B. J. (2004) · Journal of Korean Medical Science · doi:10.3346/jkms.2004.19.5.662 · Cited by 37
Predictive value of specific risk factors, symptoms and signs, in diagnosing obstructive sleep apnoea and its severity
Pillar, G., Peled, N., Katz, N., & Lavie, P. (1994) · Journal of Sleep Research · doi:10.1111/j.1365-2869.1994.tb00137.x · Cited by 31
Screening for Obstructive Sleep Apnea in Patients Presenting for Snoring Surgery
Pradhan, P. S., Gliklich, R. E., & Winkelman, J. W. (1996) · The Laryngoscope · doi:10.1097/00005537-199611000-00016 · Cited by 31
Identifying Obstructive Sleep Apnea in Patients Presenting for Laser‐Assisted Uvulopalatoplasty
Vaidya, A. M., Petruzzelli, G. J., Walker, R. P., McGee, D., & Gopalsami, C. (1996) · The Laryngoscope · doi:10.1097/00005537-199604000-00008 · Cited by 19
Systematic reviews of evaluations of diagnostic and screening tests. Odds ratio is not independent of prevalence.
Blackman, N. J. (2001) · PubMed · Cited by 14
Uptake of antenatal screening for HIV infection can be high outside London too
Dean, G. L., Fisher, M., & Ottewill, M. (2001) · BMJ · doi:10.1136/bmj.323.7322.1188b · Cited by 6

Sorted by citations

Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association
Meschia, J. F., Bushnell, C., Boden-Albala, B., Braun, L. T., Bravata, D. M., Chaturvedi, S., Creager, M. A., Eckel, R. H., Elkind, M. S. V., Fornage, M., et al. (2014) · Stroke · doi:10.1161/str.0000000000000046 · Cited by 2,650
STOP-Bang Questionnaire
Chung, F., Abdullah, H. R., & Liao, P. (2016) · Chest · doi:10.1378/chest.15-0903 · Cited by 1,362
High STOP-Bang score indicates a high probability of obstructive sleep apnoea
Chung, F., Subramanyam, R., Liao, P., Sasaki, E., Shapiro, C., & Sun, Y. (2012) · British Journal of Anaesthesia · doi:10.1093/bja/aes022 · Cited by 988
Validation of the STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea among Different Populations: A Systematic Review and Meta-Analysis
Nagappa, M., Liao, P., Wong, J., Auckley, D., Ramachandran, S. K., Memtsoudis, S., Mokhlesi, B., & Chung, F. (2015) · PLOS ONE · doi:10.1371/journal.pone.0143697 · Cited by 684
Self-citation
Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis
Chiu, H.-Y., Chen, P.-Y., Chuang, L.-P., Chen, N.-H., Tu, Y.-K., Hsieh, Y.-J., Wang, Y.-C., & Guilleminault, C. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2016.10.004 · Cited by 650

See all 297

Authors: Ramachandran, S. K., & Josephs, L. A.
Affiliations: Michigan Medicine (US)
Medical Student.
ORCID: Ramachandran, Satya Krishna
Venue: Anesthesiology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2009-04-01
Volume: 110
Issue: 4
Pages: 928-939
ISSN: 0003-3022 (ISSN-L)
DOI: 10.1097/aln.0b013e31819c47b6
OpenAlex: W2090495868
Semantic Scholar: 96975f4b61d63ccbe388c7ba3d8462ebdbdbfef0
Cited by: 297
References: 57
Citations by year: 2026: 4 · 2025: 2 · 2024: 12 · 2023: 4 · 2022: 22 · 2021: 23 · 2020: 17 · 2019: 15 · 2018: 25 · 2017: 20 · 2016: 21 · 2015: 21 · 2014: 26 · 2013: 16 · 2012: 22
FWCI: 2.52
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Anesthesiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords: obstructive sleep apnea, preoperative screening, diagnostic accuracy, false negative rate, cephalometric analysis, morphometrics, body mass index, hypertension, diagnostic odds ratio, meta-regression
MeSH terms: Clinical Protocols, Humans, Predictive Value of Tests, Surveys and Questionnaires, Risk Factors, Body Mass Index, Evidence-Based Medicine, Sleep Apnea, Obstructive

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

A Meta-analysis of Clinical Screening Tests for Obstructive Sleep Apnea

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Self-check

Citations

Cites

Cited by

Related

Metadata

Record

About these checks