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Pre-Operative Ability of Clinical Scores to Predict Obstructive Sleep Apnea (OSA) Severity in Susceptible Surgical Patients

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Abstract

Background

Severe obstructive sleep apnea (OSA) is an independent risk factor for perioperative complications. Clinical scores such as Snoring, Tiredness, Observed apnea, high blood Pressure, Body Mass Index (BMI) higher than 35 kg m−2, Age older than 50 years, Neck circumference larger than 40 cm, and male gender (STOP-Bang), perioperative sleep apnea prediction (P-SAP), and OSA50 have been proposed for detecting OSA. We recently proposed a new score based on morphological metrics only, the DES-OSA score. This study compared the DES-OSA score to the three other ones with regard to their ability to detect OSA. Obese patients are particularly at risk of OSA.

Methods

Following informed consent and institutional review board (IRB) approval, 1584 consecutive adults were. Should the STOP-Bang be indicative of increased risk of severe OSA, the patient was referred to complementary polysomnography (PSG). Eventual already existing recent PSG data were also collected. The abilities of the four scores to predict OSA severity were compared using sensitivity, specificity, Cohen’s kappa coefficient (CKC), and area under ROC curve (AUROC) analysis.

Results

PSG was performed in 150 patients. For detecting severe OSA, OSA50 had the highest sensitivity [value (95 % CI) 0.98 (0.90–1)]. STOP-Bang was significantly less sensitive than P-SAP and OSA50. In that respect, DES-OSA was significantly more specific than the three other ones [0.75 (0.65–0.83)]. The AUROC of DES-OSA was significantly the largest [0.9 (0.84–0.95)]. The highest CKC at detecting severe OSA was 0.62 (0.49–0.74) for DES-OSA. Similar results were obtained for moderate to severe OSA prediction.

Conclusions

DES-OSA, which is the only exclusively morphological score available, appears to surpass the three other scores in their ability to predict moderate to severe and severe OSA, at least in our setting and in our screened population.

Clinical Trial Registration

ClinicalTrial.gov NCT02051829

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Details of Authors’ Contributions

E.D. Study design, data analysis, and writing up of the first draft of the paper.

S.D. Patient recruitment, data collection, and writing up the first draft of the paper.

J-F.B. Writing up of the first draft of the paper.

A-F.D. Data analysis.

R.F. Patient recruitment and data collection.

R.P. Writing up of the first draft of the paper.

V.B. Study design and writing up the first draft of the paper.

Author information

Authors and Affiliations

  1. Department of Anesthesia, Clinique Saint-Luc of Bouge, Namur, Belgium

    E. Deflandre

  2. Cabinet Medical ASTES, Jambes, Belgium

    E. Deflandre & S. Degey

  3. University of Liege, Chaussee de Tongres, 29, 4000, Liege, Belgium

    E. Deflandre

  4. Department of Anesthesia, University Hospital of Liege, University of Liege, Liege, Belgium

    J-F. Brichant

  5. Department of Health Science, University of Liege, Liege, Belgium

    A-F. Donneau

  6. Department of Pneumology, Clinique Saint-Luc of Bouge, Namur, Belgium

    R. Frognier

  7. Department of Neurology, University of Liege, Liege, Belgium

    R. Poirrier

  8. University Department of Anesthesia and ICM, CHR Citadelle and CHU, Liege, Belgium

    V. Bonhomme

Authors
  1. E. Deflandre
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  2. S. Degey
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  3. J-F. Brichant
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  4. A-F. Donneau
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  5. R. Frognier
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Corresponding author

Correspondence to E. Deflandre.

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Funding

None.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of Informed Consent

Informed consent was obtained orally from all individual participants included in the study.

Additional information

This report was previously presented, in part at the ASA Annual Meeting (San Diego, 2015) and SASM Annual Meeting (San Diego, 2015). It won the third best clinical poster award at the SASM meeting.

Appendix 1

Appendix 1

Table 5 The DES-OSA score
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Table 6 Statistics observed for multiple threshold values of the STOP-Bang score in terms of number of true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (−LR) at detecting an AHI >5, >15, and >30 events/h
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Table 7 Statistics observed for multiple threshold values of the P-SAP score in terms of number of true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (−LR) at detecting an AHI >5, >15, and >30 events/h
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Table 8 Statistics observed for multiple threshold values of the OSA50 score in terms of number of true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (−LR) at detecting an AHI >5, >15, and >30 events/h
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Table 9 Statistics observed for multiple threshold values of the DES-OSA score in terms of number of true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (−LR) at detecting an AHI >5, >15, and >30 events/h
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Table 10 Comparison of sensibilities and specificities of the four scores at predicting an AHI value >5, >15, and >30 events/h (at least mild, moderate to severe, and severe OSA, respectively) using the Mc Nemar test
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Table 11 Comparison of the areas under ROC curves describing the ability of the four scores at detecting an AHI value >5, >15, and >30 events/h (at least mild, moderate to severe, and severe OSA, respectively) using a z test
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Table 12 Percentage of patients with a positive result in each of the four analyzed score
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Deflandre, E., Degey, S., Brichant, JF. et al. Pre-Operative Ability of Clinical Scores to Predict Obstructive Sleep Apnea (OSA) Severity in Susceptible Surgical Patients. OBES SURG 27, 716–729 (2017). https://doi.org/10.1007/s11695-016-2352-4

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