The Screening Value Of ESS, SACS, BQ, And SBQ On Obstructive Sleep Apnea In Patients With Chronic Obstructive Pulmonary Disease

Figures & data

Figure 1 Study flow diagram.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Table 1 Characteristics Of COPD Cohort And Comparison With OVS

Characteristics	COPD Cohort (n = 431)	COPD Without OSA Group (n = 96)	OVS Group (n = 335)	X^2/t/z	P
Gender (male/female)	388/43	86/10	302/33	0.027	0.870
Age (yrs)	67.4±8.9	65.8±8.5	67.9±9.0	−2.226	0.026
BMI (kg/m^2)	22.3±3.7	21.0±3.2	22.6±3.8	−3.874	<0.001
NC (cm)	37.8±2.9	37.0±2.7	38.1±2.9	−3.366	0.001
Hypertensive (n, %)	154(35.7%)	27(28.1%)	127(37.9%)	3.111	0.078
SI (pack/yr)	39.6±27.1	36.1±27.3	40.6±27.0	−2.172	0.030
FEV1(L)	1.8±7.4	1.2±0.6	2.2±8.4	−2.176	0.030
FEV1%	53.0±21.7	47.8±19.5	51.5±22.1	−2.600	0.009
AHI (events/h)	14.8±13.9	2.5±1.4	18.3±13.9	−14.945	<0.001
TS90%	13.4±24.2	9.8±21.6	14.4±24.8	−3.089	0.002
LSaO2 (%)	78.0±12.5	81.7±10.9	76.9±12.7	−4.570	<0.001
MSaO2 (%)	91.8±8.4	91.0±13.4	92.0±6.4	−1.737	0.082

Abbreviations: OSA, Obstructive sleep apnea; COPD, Chronic obstructive pulmonary disease; OVS, overlap syndrome; BMI, body mass index; NC, neck circumference; SI, smoking index; FEV₁, forced expiratory volume in 1 second; TS90%, percentage of total sleep time spent with pulse oxygen saturation of < 90%; LSaO₂, lowest pulse oxygen saturation; MSaO₂, mean pulse oxygen saturation.

Table 2 Descriptive Characteristics Of The Study Population For ESS, SACS, BQ And SBQ

	OVS Group (n = 335)	COPD With Mild OSA (n=183)	COPD With Moderate OSA (n=96)	COPD With Severe OSA (n=56)	X2/F	P
SQB	4.0 ± 1.2	3.6 ± 1.0	4.1 ± 1.2	5.1 ± 1.1	65.897	<0.001
Snore loudly	213 (63.6%)	113 (61.7%)	59 (61.5%)	41 (73.2%)	2.688	0.261
Daytime tiredness	186 (55.5%)	87 (47.5%)	60 (62.5%)	39 (69.6%)	11.102	0.004
Witnessed to stop breathing	107 (31.9%)	40 (21.9%)	30 (31.3%)	37 (66.1%)	38.473	<0.001
Hypertensive	127 (37.9%)	59 (32.2%)	40 (41.7%)	28 (50.0%)	6.533	0.038
BMI>35 kg/m^2	0	0	0	0	0	0
Age > 50 years	326 (97.3%)	179 (97.8%)	94 (97.9%)	53 (94.6%)	1.831	0.400
NC> 40cm	59 (17.6%)	18 (9.8%)	21 (21.9%)	20 (35.7%)	21.411	<0.001
Gender Male	302 (90.1%)	160 (87.4%)	88 (91.7%)	54 (96.4%)	4.245	0.120
SBQ≥3	311 (92.8%)	164 (89.6%)	91 (94.8%)	56 (100.0%)	7.701	0.021
BQ	1.2 ± 0.8	1.1 ± 0.7	1.2 ± 0.9	1.8 ± 0.8	27.096	<0.001
Category 1	214 (63.9%)	111 (60.7%)	60 (62.5%)	43 (76.8%)	4.931	0.085
Category 2	63 (18.8%)	22 (12.0%)	13 (13.5%)	28 (50.0)	42.817	<0.001
Category 3	132 (39.4%)	60 (32.8%)	44 (45.8%)	28 (50.0)	7.628	0.022
BQ≥2	120 (35.7%)	48 (26.2%)	36 (37.5%)	36 (64.3%)	27.783	<0.001
ESS	7.1 ± 3.6	6.6 ± 3.4	7.1 ± 3.3	8.9 ± 4.1	15.595	<0.001
ESS≥9	121 (36.1%)	54 (29.5%)	35 (36.5%)	32 (57.1%)	14.156	0.001
SACS	8. 2± 7.8	6.3 ± 6.1	8.9 ± 8.1	13.0 ± 9.6	37.115	<0.001
SACS≥15	48 (14.3%)	16 (8.7%)	16 (16.7%)	16 (28.6%)	14.290	0.001

Abbreviations: OSA, obstructive sleep apnea; COPD, chronic obstructive pulmonary disease; BMI, body mass index; NC, neck circumference; ESS, Epworth sleepiness scale; SACS, sleep apnea clinical score; BQ, Berlin Questionnaire; SBQ, STOP-BANG questionnaire.

Table 3 Predictive Parameters Of ESS, SACS, BQ, And SBQ

	Cut Off	Sensitivity (%,95% CI)	Specificity (%, 95% CI)	+LR	LR	Odds Ratio (95% CI)	AUC (95% CI)	P
AHI≥5
ESS	>4	72.2 (67.1–77.0)	46.9 (36.6–57.3)	1.36	0.59	1.107 (1.032–1.186)	0.609 (0.561–0.655)	0.001
SACS	>3	71.0 (65.9–75.8)	52.1 (41.6–62.4)	1.48	0.56	1.096 (1.043–1.151)	0.640 (0.592–0.685)	<0.001
BQ	>0	81.2 (76.6–85.2)	39.6 (29.7–50.1)	1.34	0.48	1.895 (1.402–2.562)	0.634 (0.587–0.680)	<0.001
SBQ	>2	92.8 (89.5–95.4)	40.6 (30.7–51.1)	1.56	0.18	2.161 (1.704–2.742)	0.723 (0.678–0.764)	<0.001
AHI≥15
ESS	>6	62.5 (54.3–70.2)	59.5 (53.5–65.3)	1.54	0.63	1.115 (1.054–1.179)	0.611 (0.563–0.657)	<0.001
SACS	>6	56.6 (48.3–64.6)	73.1 (67.5–78.2)	2.10	0.59	1.095 (1.061–1.130)	0.681 (0.635–0.725)	<0.001
BQ	>1	47.4 (39.2–55.6)	76.0 (70.5–80.9)	1.97	0.69	1.995 (1.547–2.573)	0.645 (0.597–0.690)	<0.001
SBQ	>3	77.6 (70.2–84.0)	55.6 (49.5–61.5)	1.75	0.40	2.215 (1.809–2.711)	0.737 (0.693–0.778)	<0.001
AHI≥30
ESS	>8	57.1 (43.2–70.3)	70.7 (65.8–75.2)	1.95	0.61	1.191 (1.103–1.286)	0.676 (0.630–0.720)	<0.001
SACS	>7	69.6 (55.9–81.2)	71.7 (66.9–76.2)	2.46	0.42	1.093 (1.058–1.129)	0.750 (0.706–0.790)	<0.001
BQ	>1	64.3 (50.4–76.6)	72.5 (67.7–77.0)	2.34	0.49	3.132 (2.145–4.573)	0.735 (0.691–0.776)	<0.001
SBQ	>4	66.1 (52.2–78.2)	82.1 (77.9–85.9)	3.70	0.41	2.977 (2.232–3.970)	0.824 (0.785–0.859)	<0.001

Abbreviations: ESS; Epworth sleepiness scale; OSA, obstructive sleep apnea; SACS, sleep apnea clinical score; BQ, Berlin Questionnaire; SBQ, STOP-BANG questionnaire; CI, confidence interval; + LR, positive likelihood ratio; - LR, negative likelihood ratio; AUC, area under curve.

Figure 2 ROC curves for ESS, SACS, BQ, and SBQ in predicting mild-moderate-severe OSA (AHI ≥5 events/h) in patients with COPD.

Figure 3 ROC curves for ESS, SACS, BQ, and SBQ in predicting moderate-to-severe OSA (AHI ≥15 events/h) in patients with COPD.

Figure 4 ROC curves for ESS, SACS, BQ, and SBQ in detecting severe OSA (AHI ≥30 events/h) in patients with COPD.

Table 4 Pairwise Comparison Of ROC Curves Of ESS, SACS, BQ, And SBQ

	ESS-SACS	ESS-BQ	ESS-SBQ	SACS-BQ	SACS-SBQ	BQ-SBQ
AHI≥5
Difference of AUC  95% CI	0.031 –0.056−0.118	0.026 –0.053−0.105	0.114 0.047–0.181	0.005 –0.042−0.053	0.083 0.038–0.128	0.088 0.047–0.130
z	0.699	0.638	3.335	0.219	3.637	4.198
P	0.485	0.523	0.001	0.826	<0.001	<0.001
AHI≥15
Difference of AUC  95% CI	0.070 0.001–0.140	0.039 –0.029−0.097	0.126 0.070–0.182	0.037 –0.003−0.076	0.056 0.019–0.093	0.092 0.055–0.129
z	1.973	1.049	4.410	1.834	2.929	4.882
P	0.049	0.294	<0.001	0.067	0.003	<0.001
AHI≥30
Difference of AUC  95% CI	0.074 –0.012−0.160	0.059 –0.023−0.141	0.148 0.078–0.218	0.015 –0.034−0.064	0.074 0.030–0.118	0.089 0.045–0.134
z	1.689	1.404	4.144	0.606	3.294	3.911
P	0.091	0.160	<0.001	0.544	0.001	<0.001

Abbreviations: ESS, Epworth sleepiness scale; SACS, sleep apnea clinical score; BQ, Berlin Questionnaire; SBQ, STOP-BANG questionnaire; AUC, area under curve; CI, confidence interval.