Diagnostic accuracy of a two-stage model for detecting obstructive sleep apnoea in chronic tetraplegia

AuthorsGraco, M.
Schembri, R.
Cross, S.
Thiyagarajan, C.
Shafazand, S.
Ayas, N.T.
Nash, M.S.
Vu, V.H.
Ruehland, W.R.
Chai-Coetzer, C. L.
Rochford, P.
Churchward, T.
Green, S.E.
Berlowitz, D.J.
TypeJournal Article (Original Research)
PubMed ID29735608
Year of Publication2018
Download thoraxjnl-2017-211131full_.pdf (633.4 KB)
AbstractBACKGROUND: Obstructive sleep apnoea (OSA) is highly prevalent in people with spinal cord injury (SCI). Polysomnography (PSG) is the gold-standard diagnostic test for OSA, however PSG is expensive and frequently inaccessible, especially in SCI. A two-stage model, incorporating a questionnaire followed by oximetry, has been found to accurately detect moderate to severe OSA (MS-OSA) in a non-disabled primary care population. This study investigated the accuracy of the two-stage model in chronic tetraplegia using both the original model and a modified version for tetraplegia. METHODS: An existing data set of 78 people with tetraplegia was used to modify the original two-stage model. Multivariable analysis identified significant risk factors for inclusion in a new tetraplegia-specific questionnaire. Receiver operating characteristic (ROC) curve analyses of the questionnaires and oximetry established thresholds for diagnosing MS-OSA. The accuracy of both models in diagnosing MS-OSA was prospectively evaluated in 100 participants with chronic tetraplegia across four international SCI units. RESULTS: Injury completeness, sleepiness, self-reported snoring and apnoeas were included in the modified questionnaire, which was highly predictive of MS-OSA (ROC area under the curve 0.87 (95% CI 0.79 to 0.95)). The 3% oxygen desaturation index was also highly predictive (0.93 (0.87-0.98)). The two-stage model with modified questionnaire had a sensitivity and specificity of 83% (66-93) and 88% (75-94) in the development group, and 77% (65-87) and 81% (68-90) in the validation group. Similar results were demonstrated with the original model. CONCLUSION: Implementation of this simple alternative to full PSG could substantially increase the detection of OSA in patients with tetraplegia and improve access to treatments. TRIAL REGISTRATION NUMBER: Results, ACTRN12615000896572 (The Australian and New Zealand Clinical Trials Registry) and pre-results, NCT02176928 (clinicaltrials.gov).


< More publications

Notch monitoring in sleepNOTCH MONITORING IN SLEEP

Sleep apnea is a condition where breathing is abnormal during sleep. There are two main forms of sleep apnea: obstructive and central. For obstructive sleep apnea, breathing is reduced because the airway...


Each year in Australia 260 people sustain a SCI, with over half losing full function in their arms and legs (quadriplegia). In addition to the primary disability, there is a very high rate of Obstructive...

IBAS Director Anna Burke unveiling of her portrait at Canberra's Parliament HouseIBAS DIRECTOR ANNA BURKE UNVEILING OF HER PORTRAIT AT CANBERRA'S PARLIAMENT HOUSE

Anna Burke had barely got into the swing of her speech at the unveiling of her portrait at Canberra's Parliament House when the ringing of bells caused half her audience to hurry away

Thunderstorm asthma expected to return in 2017THUNDERSTORM ASTHMA EXPECTED TO RETURN IN 2017

The Morning Show - Thunderstorm asthma expected to return in 2017. The Daily Edition - Thunderstorm Asthma is an unexpected killer. Better Health Channel - Thunderstorm asthma explained. Professor Christine McDonald

National study offers hope for breathlessnessNATIONAL STUDY OFFERS HOPE FOR BREATHLESSNESS

A national medication study is aiming to help thousands of Australians who struggle every day with shortness of breath

Helping Victorians breathe and sleep easy - A New Centre of Excellence in Respiratory and Sleep MedicineHELPING VICTORIANS BREATHE AND SLEEP EASY - A NEW CENTRE OF EXCELLENCE IN RESPIRATORY AND SLEEP MEDICINE

With your support we will build a life-changing Centre of Excellence in Respiratory and Sleep Medicine, improving quality of life and health outcomes for Victorians who struggle to breathe and sleep

Institute for Breathing and Sleep

Bowen Centre, Austin Hospital
145 Studley Road
Heidelberg, Victoria, 3084

(03) 9496 5390

Email Us