Factors related to sleep apnea syndrome in sleep clinic patients.

Centre Hospitalier Lyon Sud, Lyons, Rhône-Alpes, France
Chest (Impact Factor: 7.13). 07/1994; 105(6):1753-8. DOI: 10.1378/chest.105.6.1753
Source: PubMed

ABSTRACT We examined 129 patients recruited from two sleep clinics to study the sleep apnea syndrome (SAS), defined by the apnea-hypopnea index (AHI) > or = 10. Information was registered from a self-administered questionnaire, basal physical measurements, and polysomnography. In 68 subjects recorded for two consecutive nights, a high correlation was found between first- and second-night AHIs (r = 0.89). Habitual loud snoring and breathing arrests during sleep were associated with AHI > or = 10. A model including these two variables, sex, age, and body mass index was created in order to predict AHI > or = 10 and with which it was possible to successfully classify almost three of four patients. Among subjective sleep questionnaire items, only daytime sleepiness was related to drops of transcutaneous oxygen tension. These discrepancies in the observed relationship between sleep parameters and subjective sleep items reduce the questionnaire value in epidemiologic settings where it aimed to detect SAS, as defined solely by the AHI value.

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    ABSTRACT: Background The increased prevalence of obstructive sleep apnea (OSA) mandates the presence of simple but accurate tools to identify patients with this disorder for early detection and prevention of various serious consequences. This study aimed at comparing four sleep questionnaires as regards their predictive probabilities for OSA.MethodsA cross-sectional study included 234 patients presenting to the sleep clinic. Four sleep questionnaires (Berlin, Epworth Sleepiness Scale [ESS], STOP, and STOP-Bang) were administered to the patients and scoring of the results of the questionnaires was done. Overnight attended polysomnography (PSG) was done for all patients and was considered the gold standard for the diagnosis of OSA. The sensitivity, specificity, positive and negative predictive values of the four questionnaires were calculated.ResultsOf 234 screened patients; 87.1% had OSA, whereas 93.3%, 90.2%, 95.5%, and 68.3% were classified as being at high risk by the Berlin, STOP, STOP-Bang questionnaires and ESS, respectively. The STOP-Bang, Berlin and STOP questionnaires had the highest sensitivity to predict OSA (97.55%, 95.07% and 91.67%, respectively), moderate-to-severe OSA (97.74%, 95.48% and 94.35%, respectively) and severe OSA (98.65%, 97.3% and 95.95%, respectively), but with a very low specificity for OSA patients (26.32%, 25% and 25%, respectively), moderate-to-severe OSA patients (3.7%, 7.41% and 25.93%, respectively) and severe OSA patients (5.36%, 10.71% and 19.64%, respectively), while the ESS had the highest specificity to predict OSA, moderate-to-severe OSA and severe OSA (75%, 48.15% and 46.43%, respectively) but with the lowest sensitivity (72.55%, 75.71% and 79.73%, respectively).Conclusions The sensitivity of Berlin, STOP and STOP-Bang questionnaires was very high yet, the low specificity of these questionnaires results in increased false positives and failure of exclusion of individuals at low risk.
    10/2012; 61(4):433–441. DOI:10.1016/j.ejcdt.2012.07.003
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    Revista medica de Chile 08/2010; 138(8):941-950. DOI:10.4067/S0034-98872010000800001 · 0.37 Impact Factor
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    ABSTRACT: Abstract Objective: Opioid analgesics are commonly and increasingly prescribed by physicians for the management of chronic pain. However, strong evidence supports the need for strategies that reduce opioid use. The objective of this review is to outline limitations associated with opioid use and discuss therapeutic techniques that can be adopted to optimize the use of opioids in the management of chronic pain. Scope: Literature searches through MEDLINE and Cochrane databases were used to identify relevant journal articles. The search was limited to articles published from January 1980 to January 2014. Additional references were obtained from articles extracted during the database search. Relevant search terms included opioid, opioid abuse, chronic pain management, written care agreements, urine drug testing, and multimodal therapy. Findings: Opioids exhibit a well-established abuse potential and evidence supporting the efficacy of opioids in chronic pain management is limited. In addition, opioid exposure is associated with adverse effects on multiple organ systems. Effective strategies designed to mitigate opioid abuse and diversion and optimize clinical outcomes should be employed. Conclusions: Appropriate patient selection through identification of risk factors, urine drug testing, and access to prescription monitoring programs has been shown to effectively improve care. Structured opioid therapy in a multimodal platform including use of a low initial dose, prescription of alternative non-opioid analgesics including non-steroidal inflammatory drugs and acetaminophen, as well as development of written care agreements to individualize and guide therapy has also been shown to improve patient outcomes. Implementation of opioid allocation strategies has the potential to encourage appropriate opioid use and improve patient care.
    Current Medical Research and Opinion 05/2014; 30(10). DOI:10.1185/03007995.2014.921610 · 2.37 Impact Factor


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