Performance of Four Screening Tools for Identifying Obstructive Sleep Apnea Among Patients with Insomnia
Chuan Shi,* Yuxin Wang,* Jinmei Luo, Rong Huang, Yi Xiao Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, People’s Republic of China*T...
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Dove Medical Press
2025-03-01
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| Series: | Nature and Science of Sleep |
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| author | Shi C Wang Y Luo J Huang R Xiao Y |
| author_facet | Shi C Wang Y Luo J Huang R Xiao Y |
| author_sort | Shi C |
| collection | DOAJ |
| description | Chuan Shi,* Yuxin Wang,* Jinmei Luo, Rong Huang, Yi Xiao Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinmei Luo, Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, People’s Republic of China, Email palmljm@126.comPurpose: Co-morbid insomnia and sleep apnea are common in clinical practice. The existing OSA screening tools have not been fully validated in insomnia populations, and items measuring daytime function may be interfered with the presence of insomnia. This study aims to validate the performance of four commonly used OSA screening tools among individuals with and without insomnia.Participants and Methods: A cross-sectional survey was conducted in individuals with suspected OSA referred for sleep studies from December 2021 to December 2023. All participants completed the Insomnia Severity Index (ISI) scale, STOP-Bang, Epworth Sleepiness Scale (ESS), Berlin questionnaire, and NoSAS score. Clinical insomnia was defined as an ISI of 15 or more. Performance of screening tools was primarily assessed by sensitivity, specificity, and the receiver operating characteristic (ROC) curve.Results: A total of 1266 participants (26% females, age 46.4 ± 12.4 years) were included in the study. The prevalence of apnea-hypopnea index (AHI) ≥ 15/h was 48% and 52% in the insomnia (n=313) and non-insomnia (n=953) group, respectively (P> 0.05). In presence of insomnia, the STOP-Bang, ESS, and Berlin questionnaire demonstrated higher sensitivity but lower specificity. Using conventional cutoffs, the STOP-Bang had the highest level of sensitivity (93.2%, 95% CI 87.6– 96.5%), while NoSAS had the highest level of specificity (67.7%, 95% CI 59.9– 74.6%) for identifying AHI ≥ 15/h. The STOP-Bang and NoSAS outperformed ESS and Berlin with areas under the ROC curve > 0.7 at all levels of OSA severity. The Youden’s index was maximized at score 4 for STOP-Bang and score 7 for NoSAS.Conclusion: The performance of OSA screening tools incorporating evaluation of daytime function is altered in the presence of insomnia. Under conventional cutoffs, STOP-Bang is the preferred screening tool due to its high sensitivity.Keywords: obstructive sleep apnea, insomnia, screening instruments, polysomnography |
| format | Article |
| id | doaj-art-79d76ca962cb474ba65c0e3bee106bf9 |
| institution | OA Journals |
| issn | 1179-1608 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Dove Medical Press |
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| series | Nature and Science of Sleep |
| spelling | doaj-art-79d76ca962cb474ba65c0e3bee106bf92025-08-20T02:03:06ZengDove Medical PressNature and Science of Sleep1179-16082025-03-01Volume 17379390100760Performance of Four Screening Tools for Identifying Obstructive Sleep Apnea Among Patients with InsomniaShi CWang YLuo JHuang RXiao YChuan Shi,* Yuxin Wang,* Jinmei Luo, Rong Huang, Yi Xiao Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinmei Luo, Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, People’s Republic of China, Email palmljm@126.comPurpose: Co-morbid insomnia and sleep apnea are common in clinical practice. The existing OSA screening tools have not been fully validated in insomnia populations, and items measuring daytime function may be interfered with the presence of insomnia. This study aims to validate the performance of four commonly used OSA screening tools among individuals with and without insomnia.Participants and Methods: A cross-sectional survey was conducted in individuals with suspected OSA referred for sleep studies from December 2021 to December 2023. All participants completed the Insomnia Severity Index (ISI) scale, STOP-Bang, Epworth Sleepiness Scale (ESS), Berlin questionnaire, and NoSAS score. Clinical insomnia was defined as an ISI of 15 or more. Performance of screening tools was primarily assessed by sensitivity, specificity, and the receiver operating characteristic (ROC) curve.Results: A total of 1266 participants (26% females, age 46.4 ± 12.4 years) were included in the study. The prevalence of apnea-hypopnea index (AHI) ≥ 15/h was 48% and 52% in the insomnia (n=313) and non-insomnia (n=953) group, respectively (P> 0.05). In presence of insomnia, the STOP-Bang, ESS, and Berlin questionnaire demonstrated higher sensitivity but lower specificity. Using conventional cutoffs, the STOP-Bang had the highest level of sensitivity (93.2%, 95% CI 87.6– 96.5%), while NoSAS had the highest level of specificity (67.7%, 95% CI 59.9– 74.6%) for identifying AHI ≥ 15/h. The STOP-Bang and NoSAS outperformed ESS and Berlin with areas under the ROC curve > 0.7 at all levels of OSA severity. The Youden’s index was maximized at score 4 for STOP-Bang and score 7 for NoSAS.Conclusion: The performance of OSA screening tools incorporating evaluation of daytime function is altered in the presence of insomnia. Under conventional cutoffs, STOP-Bang is the preferred screening tool due to its high sensitivity.Keywords: obstructive sleep apnea, insomnia, screening instruments, polysomnographyhttps://www.dovepress.com/performance-of-four-screening-tools-for-identifying-obstructive-sleep--peer-reviewed-fulltext-article-NSSobstructive sleep apneainsomniascreening instrumentspolysomnography |
| spellingShingle | Shi C Wang Y Luo J Huang R Xiao Y Performance of Four Screening Tools for Identifying Obstructive Sleep Apnea Among Patients with Insomnia Nature and Science of Sleep obstructive sleep apnea insomnia screening instruments polysomnography |
| title | Performance of Four Screening Tools for Identifying Obstructive Sleep Apnea Among Patients with Insomnia |
| title_full | Performance of Four Screening Tools for Identifying Obstructive Sleep Apnea Among Patients with Insomnia |
| title_fullStr | Performance of Four Screening Tools for Identifying Obstructive Sleep Apnea Among Patients with Insomnia |
| title_full_unstemmed | Performance of Four Screening Tools for Identifying Obstructive Sleep Apnea Among Patients with Insomnia |
| title_short | Performance of Four Screening Tools for Identifying Obstructive Sleep Apnea Among Patients with Insomnia |
| title_sort | performance of four screening tools for identifying obstructive sleep apnea among patients with insomnia |
| topic | obstructive sleep apnea insomnia screening instruments polysomnography |
| url | https://www.dovepress.com/performance-of-four-screening-tools-for-identifying-obstructive-sleep--peer-reviewed-fulltext-article-NSS |
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