0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Are History and Physical Examination a Good Screening Test for Sleep Apnea?

Sidney Viner, MD; John P. Szalai, PhD; and Victor Hoffstein, MD, PhD
[+] Article and Author Information

Requests for Reprints: Victor Hoffstein, MD, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8.

Current Author Addresses: Dr. Hoffstein: St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8.

Dr. Szalai: Sunnybrook Health Sciences Centre, Department of Research Design Biostatistics, Room 45, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5.

Dr. Viner: Bow Valley Centre of the Calgary General Hospital, 841 Centre Avenue East, Calgary, Alberta T2E OA1.


© 1991 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1991;115(5):356-359. doi:10.7326/0003-4819-115-5-356
Text Size: A A A

Objective: To determine whether presenting clinical history, pharyngeal examination, and the overall subjective impression of the clinician could serve as a sensitive screening test for sleep apnea.

Design: Blinded comparison of history and physical examination with results of nocturnal polysomnography.

Setting: Sleep clinic of a tertiary referral center.

Patients: A total of 410 patients referred for suspected sleep apnea syndrome. Most patients reported snoring.

Measurements: All patients were asked standard questions and given an examination relevant to the diagnosis of the sleep apnea syndrome, and all had full nocturnal polysomnography. Patients with more than ten episodes of apnea or hypopnea per hour of sleep were classified as having sleep apnea. Stepwise linear logistic regression was used to develop two predictive models of sleep apnea: one based on the presence of characteristic clinical features, age, sex, and body mass index; and one based on subjective clinical impression.

Results: The prevalence of sleep apnea in our patients was 46%. Only age, body mass index, male sex, and snoring were found to be predictors of sleep apnea. The logistic rule discriminated between patients with and without sleep apnea (receiver operating characteristic [ROC] area, 0.77 [95% Cl, 0.73 to 0.82]). For patients with a predicted probability of apnea of less than 20%, the clinical model had 94% sensitivity and 28% specificity. Subjective impression alone identified correctly only 52% of patients with sleep apnea and had a specificity of 70%.

Conclusions: In patients with a high predicted probability of the sleep apnea syndrome, subjective impression alone or any combination of clinical features cannot serve as a reliable screening test. However, in patients with a low predicted probability of sleep apnea, the model based on clinical data was sufficiently sensitive to permit about a 30% reduction in the number of unnecessary sleep studies.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)