A simplified model of screening questionnaire and home monitoring for obstructive sleep apnoea in primary care
Open accessAbstract
BACKGROUND: To address the growing burden of disease and long waiting lists for sleep services, a simplified two-stage model was developed and validated for identifying obstructive sleep apnoea (OSA) in primary care using a screening questionnaire followed by home sleep monitoring. METHODS: 157 patients aged 25-70 years attending their primary care physician for any reason at six primary care clinics in rural and metropolitan regions of South Australia participated. The first 79 patients formed the development group and the next 78 patients the validation group. A screening questionnaire was developed from factors identified from sleep surveys, demographic and anthropometric data to be predictive of moderate to severe OSA. Receiver operating characteristic (ROC) curve analysis was used to validate the two-channel ApneaLink device against full polysomnography. The diagnostic accuracy of the overall two-stage model was then evaluated. RESULTS: Snoring, waist circumference, witnessed apnoeas and age were predictive of OSA and incorporated into a screening questionnaire (ROC area under curve (AUC) 0.84, 95% CI 0.75 to 0.94, p<0.001). ApneaLink oximetry with a 3% dip rate was highly predictive of OSA (AUC 0.96, 95% CI 0.91 to 1.0, p<0.001). The two-stage diagnostic model showed a sensitivity of 0.97 (95% CI 0.81 to 1.00) and specificity of 0.87 (95% CI 0.74 to 0.95) in the development group, and a sensitivity of 0.88 (95% CI 0.60 to 0.98) and specificity of 0.82 (95% CI 0.70 to 0.90) in the validation group. CONCLUSION: A two-stage model of screening questionnaire followed by home oximetry can accurately identify patients with OSA in primary care and has the potential to expedite care for patients with this common sleep disorder.
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Using a cutoff of AHI ≥ 30, accuracy of 2-3 channel HSAT against unattended in-home PSG ranged from 83% to 91%.
“using a cutoff of AHI ≥ 30, accuracy ranged from 83% to 91%”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [81]
The Two-stage diagnostic model section reports 91% overall accuracy in the development group, and the Validation data set section reports 83% in the validation group, using PSG AHI ≥30/h as the disease threshold. Those figures are for a questionnaire followed by two-channel home monitoring, not for the home sleep test alone against PSG. (LLM, conf=0.90)
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- Authors
- Chai-Coetzer, C. L., Antic, N. A., Rowland, L. S., Catcheside, P. G., Esterman, A., Reed, R. L., Williams, H., Dunn, S., & McEvoy, R. D.
- Affiliations
- Flinders University (AU)
- Repatriation General Hospital (AU)
- University of South Australia (AU)
- Charles Darwin University (AU)
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2011-01-20
- Volume
- 66
- Issue
- 3
- Pages
- 213-219
- ISSN
- 0040-6376 (ISSN-L)
- OpenAlex
- W2119317330
- Cited by
- 233
- References
- 9
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 15 · 2023: 21 · 2022: 23 · 2021: 28 · 2020: 17 · 2019: 13 · 2018: 23 · 2017: 14 · 2016: 15 · 2015: 14 · 2014: 10 · 2013: 14 · 2012: 9
- FWCI
- 7.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline - JCU (James Cook University) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- ResMed
- Medical Research Council
- National Health and Medical Research Council (426744)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- obstructive sleep apnea, sleep apnea screening, home sleep monitoring, oximetry, ApneaLink, screening questionnaire, snoring, waist circumference, primary care, diagnostic accuracy
- MeSH terms
- Adult, Age Factors, Aged, Anthropometry, Decision Support Techniques, Epidemiologic Methods, Female, Home Care Services, Humans, Male, Mass Screening, Middle Aged, Primary Health Care, Snoring, South Australia, Sleep Apnea, Obstructive, Waist Circumference
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