Nocturnal oximetry in the diagnosis of obstructive sleep apnea syndrome in potentially hypoxic patients due to neuromuscular diseases.

INTRODUCTION: Polysomnography is the recommended method for the diagnosis of obstructive sleep apnea (OSA); however, it is expensive, uncomfortable, and inaccessible. Alternative diagnostic methods are necessary, and Nocturnal Oximetry (NO) has proven to be reliable. Nevertheless, there have been doubts about its accuracy in patients with a history of hypoxia. Hence, the objective of this study was to evaluate the performance of NO in patients with neuromuscular diseases (NMD). METHOD: This was a cross-sectional study in patients with NMD suspected of having OSA. We performed a statistical analysis using Spearman's correlation coefficients (SCCs). We used the value of the area under the ROC curve (AUCROC), just as we calculated the sensitivities (Sens) and specificities (Spec) for the chosen variables. RESULTS: The sample comprised 41 patients; 51.2% with muscular dystrophies and 48.8% with motor neuron diseases, with a predominance of men (63.4%). Median age was 42 (19.7-55) years, body mass index (BMI) was 27.9 (23.8-32) kg/m2, forced vital capacity was 67% (54%-76.5%), and maximum inspiratory pressure was-60 cmH2O (-87.5 to -50). The prevalence of OSA was 75.7%. We analyzed and selected the best four oximetric variables with the following performance in identifying the apnea/hypopnea index >5/h, ODI3/2, cutoff>5/h, AUCROC 0.919, Sens 82.3%, Spec 91.7%; ODI3/5, cutoff>11.2/h, AUCROC 0.904, Sens 82.3%, Spec 87.5%; ODI4/5, cutoff>6.02, AUCROC 0.839, Sens 70.6%, Spec 91.6%, and ODI5/5, cutoff>0.87/h, AUCROC 0.870, Sens 94.1%, and Spec 70.8%. CONCLUSION: NO can be used as a diagnostic tool for OSA, even in patients with neuromuscular diseases and potentially hypoxic diseases.

Diagnostic performance of nocturnal oximetry in the detection of obstructive sleep apnea syndrome: a Brazilian study.

OBJECTIVE: Due to the increasing prevalence of obstructive sleep apnea (OSA), more practical diagnostic methods than polysomnography (PSG) have become necessary. This research aims to analyze the performance of nocturnal oximetry (NO) in the diagnosis of OSA. METHODS: In this cross-sectional study, we analyzed 41 variables provided by the oximetry of all PSG performed by the LabSono of University Hospital Gaffrée and Guinle, a total of 83 exams. We evaluated the correlation coefficients (Spearman) between these data and the Apnea/Hypopnea Index (AHI) and then calculated the diagnostics performances, by the area under the curve (ROC) (AUC), of the best correlated variables and their respective cutoffs, in the identification of an AHI ≥ 15/h. RESULTS: Virtually all oximetric data showed good correlations with AHI, except for some temporal data. We chose 5 of them and calculated their diagnostic performances. T < 90% shows AUC of 0.904 (0.835-0.972) and, at cutoff > 19 min, a sensitivity (Sens.) of 75.68% and specificity (Spec.) of 95.65%. DO3/10Total, AUC 0.936 (0.888-0.989), and at the cutoff > 51 has Sens. 97.3% and Spec. 76.09%. ODI3/10/h has AUC 0.932 (0.884-0.988), at the cutoff > 7/h, Sens. 97.3% and Spec. 78.26%. DO4/5Total AUC 0.932 (0.882-0.981), at the cutoff > 64 has Sens. 86.49% and Spec. 82.61% and ODI4/5/h has AUC 0.930 (0.880-0.981), the cutoff > 5.69/h Sens. 97.3% and Spec. 73.91%. CONCLUSIONS: Our study concludes that NO is accurate in identifying AHI > 15/h, and provides reliable information on PSG replacement, which could make the diagnosis of OSA cheaper and more comfortable.

Performance of the STOP-Bang in the Detection of OSA, a Brazilian study.

OBJECTIVES: Assess the performance of the Stop-Bang questionnaire in Brazilian patients for the screening of OSA. METHODS: A cross-sectional study with historical and consecutive analysis of all patients who underwent polysomnography tests in the Sleeping Sector of the Ear, Nose, and Throat, and Cardiopulmonary (LabSono) Departments of the Gaffrée and Guinle University Hospital (HUGG), from 10/17/2011 to 04/16/2015. The variables relating to the SB questionnaire were collected by direct research from the medical records of patients. RESULTS: In a series of 83 patients, we found that our sample were similar to other studies conducted in specialized centers of Sleep Medicine, and the population presented characteristics similar to those found by studies in Latin America. Men and women only behaved similarly in relation to the presence of Observed Apnea and body mass index, with a predominance of women who had systemic hypertension over men. In our study, the discriminatory value of 4 or more positive answers to the questionnaire had the best performance in identifying patients with an hourly Apnea-Hypopnea Index greater than 15/h, with a sensitivity of 72.97% (55.9% - 86.2%) and specificity of 67.39% (52.0% - 80.5%). CONCLUSIONS: The Stop-Bang questionnaire proved to be, in our sample, a good screening instrument for diagnosing OSA Syndrome.

Performance of the STOP-Bang in the Detection of OSA, a Brazilian study

SUMMARY OBJECTIVES Assess the performance of the Stop-Bang questionnaire in Brazilian patients for the screening of OSA. METHODS A cross-sectional study with historical and consecutive analysis of all patients who underwent polysomnography tests in the Sleeping Sector of the Ear, Nose, and Throat, and Cardiopulmonary (LabSono) Departments of the Gaffrée and Guinle University Hospital (HUGG), from 10/17/2011 to 04/16/2015. The variables relating to the SB questionnaire were collected by direct research from the medical records of patients. RESULTS In a series of 83 patients, we found that our sample were similar to other studies conducted in specialized centers of Sleep Medicine, and the population presented characteristics similar to those found by studies in Latin America. Men and women only behaved similarly in relation to the presence of Observed Apnea and body mass index, with a predominance of women who had systemic hypertension over men. In our study, the discriminatory value of 4 or more positive answers to the questionnaire had the best performance in identifying patients with an hourly Apnea-Hypopnea Index greater than 15/h, with a sensitivity of 72.97% (55.9% - 86.2%) and specificity of 67.39% (52.0% - 80.5%). CONCLUSIONS The Stop-Bang questionnaire proved to be, in our sample, a good screening instrument for diagnosing OSA Syndrome.

RESUMO OBJETIVO Avaliar o desempenho no Questionário Stop-Bang (QSB) em pacientes brasileiros para rastrear a Apneia Obstrutiva do Sono. MÉTODO Estudo transversal, com análise histórica e consecutiva de todos os pacientes que realizaram exames de polissonografia pelo Setor de Sono da Otorrinolaringologia e da Cardiopulmonar (LabSono) do Hospital Universitário Gaffrée e Guinle (HUGG), no período de 17/10/2011 a 16/04/2015. As variáveis referentes ao QSB foram colhidas por pesquisa direta nos prontuários dos pacientes. RESULTADOS Numa casuística de 83 pacientes, encontramos amostras semelhantes a outros estudos realizados em Centros Especializados em Medicina do Sono, com características da população semelhantes aos estudos feitos na América Latina. Homens e mulheres só se comportaram de forma semelhante em relação à presença de apneias presenciadas e o índice de massa corporal, com um predomínio de mulheres com hipertensão arterial sistêmica sobre os homens. Em nosso estudo, o valor discriminatório de quatro ou mais respostas positivas ao questionário mostrou o melhor desempenho em identificar pacientes com um índice de apneia/hipopneia por hora maior do que 15/h, obtendo sensibilidade de 72,97% (55,9% - 86,2%) e especificidade de 67,39% (52,0% - 80,5%). CONCLUSÕES O QSB mostrou-se, em nossa amostra, um bom instrumento de rastreio da Síndrome da Apneia Obstrutiva do Sono.