Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis
- PMID: 27919588
- DOI: 10.1016/j.smrv.2016.10.004
Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder; however, it remains underdiagnosed and undertreated. Although screening tools such as the Berlin questionnaire (BQ), STOP-BANG questionnaire (SBQ), STOP questionnaire (STOP), and Epworth sleepiness scale (ESS) are widely used for OSA, the findings regarding their diagnostic accuracy are controversial. Therefore, this meta-analysis investigated and compared the summary sensitivity, specificity, and diagnostic odds ratio (DOR) among the BQ, SBQ, STOP, and ESS according to the severity of OSA. Electronic databases, namely the Embase, PubMed, PsycINFO, ProQuest dissertations and theses A&I databases, and China knowledge resource integrated database, were searched from their inception to July 15, 2016. We included studies examining the sensitivity and specificity of the BQ, SBQ, STOP, and ESS against the apnea-hypopnea index (AHI) or respiratory disturbance index (RDI). The revised quality assessment of diagnostic accuracy studies was used to evaluate the methodological quality of studies. A random-effects bivariate model was used to estimate the summary sensitivity, specificity, and DOR of the tools. We identified 108 studies including a total of 47 989 participants. The summary estimates were calculated for the BQ, SBQ, STOP, and ESS in detecting mild (AHI/RDI ≥ 5 events/h), moderate (AHI/RDI ≥ 15 events/h), and severe OSA (AHI/RDI ≥ 30 events/h). The performance levels of the BQ, SBQ, STOP, and ESS in detecting OSA of various severity levels are outlined as follows: for mild OSA, the pooled sensitivity levels were 76%, 88%, 87%, and 54%; pooled specificity levels were 59%, 42%, 42%, and 65%; and pooled DORs were 4.30, 5.13, 4.85, and 2.18, respectively. For moderate OSA, the pooled sensitivity levels were 77%, 90%, 89%, and 47%; pooled specificity levels were 44%, 36%, 32%, and 621%; and pooled DORs were 2.68, 5.05, 3.71, and 1.45, respectively. For severe OSA, the pooled sensitivity levels were 84%, 93%, 90%, and 58%; pooled specificity levels were 38%, 35%, 28%, and 60%; and pooled DORs were 3.10, 6.51, 3.37, and 2.10, respectively. Therefore, for mild, moderate, and severe OSA, the pooled sensitivity and DOR of the SBQ were significantly higher than those of other screening tools (P < .05); however, the specificity of the SBQ was lower than that of the ESS (P < .05). Moreover, age, sex, body mass index, study sample size, study populations, presence of comorbidities, PSG or portable monitoring performance, and risk of bias in the domains of the index test and reference standard were significant moderators of sensitivity and specificity (P < .05). Compared with the BQ, STOP, and ESS, the SBQ is a more accurate tool for detecting mild, moderate, and severe OSA. Sleep specialists should use the SBQ to conduct patient interviews for the early diagnosis of OSA in clinical settings, particularly in resource-poor countries and sleep clinics where PSG is unavailable.
Keywords: Diagnostic meta-analysis; Instrument validation; Obstructive sleep apnea; Screening.
Copyright © 2016 Elsevier Ltd. All rights reserved.
Comment in
-
To screen or not to screen for obstructive sleep apnea, that is the question.Sleep Med Rev. 2017 Dec;36:125-127. doi: 10.1016/j.smrv.2017.03.002. Epub 2017 Mar 22. Sleep Med Rev. 2017. PMID: 28410810 No abstract available.
Similar articles
-
[Comparison of the NoSAS score with four different questionnaires as screening tools for obstructive sleep apnea-hypopnea syndrome].Zhonghua Jie He He Hu Xi Za Zhi. 2018 Mar 12;41(3):213-219. doi: 10.3760/cma.j.issn.1001-0939.2018.03.013. Zhonghua Jie He He Hu Xi Za Zhi. 2018. PMID: 29518851 Chinese.
-
The Screening Value Of ESS, SACS, BQ, And SBQ On Obstructive Sleep Apnea In Patients With Chronic Obstructive Pulmonary Disease.Int J Chron Obstruct Pulmon Dis. 2019 Nov 13;14:2497-2505. doi: 10.2147/COPD.S223354. eCollection 2019. Int J Chron Obstruct Pulmon Dis. 2019. PMID: 32009782 Free PMC article.
-
STOP-Bang questionnaire is superior to Epworth sleepiness scales, Berlin questionnaire, and STOP questionnaire in screening obstructive sleep apnea hypopnea syndrome patients.Chin Med J (Engl). 2014;127(17):3065-70. Chin Med J (Engl). 2014. PMID: 25189946
-
Screening Questionnaires for Obstructive Sleep Apnea: An Updated Systematic Review.Oman Med J. 2018 May;33(3):184-192. doi: 10.5001/omj.2018.36. Oman Med J. 2018. PMID: 29896325 Free PMC article. Review.
-
Performance of screening questionnaires for obstructive sleep apnea during pregnancy: A systematic review and meta-analysis.Sleep Med Rev. 2017 Dec;36:96-106. doi: 10.1016/j.smrv.2016.11.003. Epub 2016 Nov 15. Sleep Med Rev. 2017. PMID: 28007402 Review.
Cited by
-
The role of serum C-Fos and glial fibriller acidic protein levels in detecting the severity of obstructive sleep apnea.Sleep Breath. 2024 Jun 5. doi: 10.1007/s11325-024-03069-2. Online ahead of print. Sleep Breath. 2024. PMID: 38836924
-
Development and application of a machine learning-based predictive model for obstructive sleep apnea screening.Front Big Data. 2024 May 16;7:1353469. doi: 10.3389/fdata.2024.1353469. eCollection 2024. Front Big Data. 2024. PMID: 38817683 Free PMC article.
-
The Association of Serum Uric Acid with Risk of Obstructive Sleep Apnea: The Korean National Health and Nutrition Examination Survey 2019-2021.J Pers Med. 2024 May 16;14(5):532. doi: 10.3390/jpm14050532. J Pers Med. 2024. PMID: 38793114 Free PMC article.
-
Evaluation and management of nonarteritic anterior ischemic optic neuropathy: a national survey.Graefes Arch Clin Exp Ophthalmol. 2024 May 15. doi: 10.1007/s00417-024-06512-y. Online ahead of print. Graefes Arch Clin Exp Ophthalmol. 2024. PMID: 38748211
-
Screening for treatment-required sleep apnoea in patients with spinal cord injury within one year after injury in a rehabilitation setting.Sleep Breath. 2024 May 15. doi: 10.1007/s11325-024-03062-9. Online ahead of print. Sleep Breath. 2024. PMID: 38748068
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical