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)
JournalThorax
PubMed ID29735608
Year of Publication2018
URLhttps://www.ncbi.nlm.nih.gov/pubmed/29735608
DOI/10.1136/thoraxjnl-2017-211131
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).

http://www.ibas.org.au/what-we-do/publications/3872949


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