A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study
Por:
Peñacoba P., Llauger M.A., Fortuna A.M., Flor X., Sampol G., Pedro-Pijoan A.M., Grau N., Santiveri C., Juvanteny J., Aoiz J.I., Bayó J., Lloberes P., Mayos M., Domínguez Olivera L., Valverde Trillo P., Santos Santos M.ªÁ., Farga Martínez M.ªM., Reverté Simó M., Argemí Saburit N., Medrano Medrano C., Puig García M.
Publicada:
15 ene 2022
Resumen:
Background: The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting.
Methods: Anthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the beta coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed.
Results: 194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763-0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% >= 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863-0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7-92.1) and specificity of 67.8% (95% CI 55.1-78.3).
Conclusions: The use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment.
Filiaciones:
Peñacoba P.:
Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Llauger M.A.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Equip d’Atenció Primària Encants, Centre d’Atenció Primària (CAP) Maragall, Institut Català de La Salut, Barcelona, Spain
Fortuna A.M.:
Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Flor X.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
CAP Chafarinas, Institut Català de La Salut, Barcelona, Spain
Sampol G.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Sleep Unit, Service of Pneumology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
Pedro-Pijoan A.M.:
Àrea Bàsica de Salut Gaudí, Consorci Sanitari Integral, Barcelona, Spain
Grau N.:
Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
Sleep Unit, Department of Respiratory Medicine, Parc de Salut Mar-IMIM, Hospital del Mar, Barcelona, Spain
Santiveri C.:
Service of Pneumology, Hospital Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain
Juvanteny J.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
CAP Trinitat Vella, Institut Català de La Salut, Barcelona, Spain
Aoiz J.I.:
CAP El Clot, Institut Català de La Salut, Barcelona, Spain
Bayó J.:
CAP El Clot, Institut Català de La Salut, Barcelona, Spain
Lloberes P.:
Sleep Unit, Service of Pneumology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
Mayos M.:
Sleep Unit, Department of Respiratory Diseases, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Investigación Carlos III, Madrid, Spain
Domínguez Olivera L.:
Equip d’Atenció Primària Encants, Centre d’Atenció Primària (CAP) Maragall, Institut Català de La Salut, Barcelona, Spain
Valverde Trillo P.:
Àrea Bàsica de Salut Gaudí, Consorci Sanitari Integral, Barcelona, Spain
Santos Santos M.ªÁ.:
CAP Chafarinas, Institut Català de La Salut, Barcelona, Spain
Farga Martínez M.ªM.:
CAP Chafarinas, Institut Català de La Salut, Barcelona, Spain
Reverté Simó M.:
CAP Trinitat Vella, Institut Català de La Salut, Barcelona, Spain
Argemí Saburit N.:
CAP El Clot, Institut Català de La Salut, Barcelona, Spain
Medrano Medrano C.:
CAP El Clot, Institut Català de La Salut, Barcelona, Spain
Puig García M.:
CAP El Clot, Institut Català de La Salut, Barcelona, Spain
All Open Access, Gold
|