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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2015, Number 4

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Rev Invest Clin 2015; 67 (4)

Diagnostic Value of the Morphometric Model and Adjusted Neck Circumference in Adults with Obstructive Sleep Apnea Syndrome

Castorena-Maldonado A, Espinosa-Morett L, Arredondo del Bosque F, Carrillo-Alduenda JL, Torre-Bouscoulet L, Vázquez-García JC, Pérez-Padilla JR

Language: English
References: 27
Page: 258-265
PDF size: 579.27 Kb.


ABSTRACT

Background: Obstructive sleep apnea syndrome is a major public health problem. The morphometric model and the Sleep Apnea Clinical Score are widely used to evaluate adults; however, neither of these tools has been validated in a Mexican population. Objective: To determine the diagnostic value of the morphometric model and the Sleep Apnea Clinical Score and compare them with conventional clinical instruments. Methods: A total of 97 individuals were recruited prospectively. Initial screening excluded 36, of whom nine were subjects without apnea; the remaining 52 were consecutive patients with obstructive sleep apnea syndrome diagnosed by nocturnal polysomnography. Diagnostic values of each test were calculated. Results: Obstructive sleep apnea syndrome patients had significantly higher scores with both instruments than controls: morphometric model: 61.3 (95% CI: 45.5-75.3) vs. 41.0 (95% CI: 35.6-45.6); Sleep Apnea Clinical Score: 45.3 (95% CI: 39.5-40.3) vs. 36 (95% CI: 34.0-36.5), respectively. For severe cases, the best cutoff point for morphometric model was 46, with a sensitivity of 81% (95% CI: 62.5-92.6) and specificity of 46.7% (95% CI: 66.4-100), while for Sleep Apnea Clinical Score it was › 48, with a sensitivity of 61% (95% CI: 46.1-74.2) and specificity of 80.4% (95% CI: 66-90.6). Conclusions: A morphometric model value of ≥ 46 or an adjusted neck circumference (Sleep Apnea Clinical Score) › 48 were adequate for diagnosing obstructive sleep apnea syndrome.


REFERENCES

  1. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL, USA. American Academy of Sleep Medicine, 2014.

  2. Bouscoulet LT, Vázquez-García JC, Muiño A, et al. PLATINO Group. Prevalence of sleep related symptoms in four Latin American cities. J Clin Sleep Med. 2008;4:579-85.

  3. Ward KL, Hillman DR, James A, et al. Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea. J Clin Sleep Med. 2013;9:1013-21.

  4. Mulgrew AT, Nasvadi G, Butt A, et al. Risk and severity of motor vehicle crashes in patients with obstructive sleep apnoea/hypopnoea. Thorax. 2008;63:536-41.

  5. Durán-Cantolla J, Aizpuru F, Martínez-Null C, Barbé-Illa F. Obstructive sleep apnea/hypopnea and systemic hypertension. Sleep Med Rev. 2009;13:323-31.

  6. Alam I, Lewis K, Stephens JW, Baxter JN. Obesity, metabolic syndrome and sleep apnoea: All pro-inflammatory states. Obesity Rev. 2006;8:119-27.

  7. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046-53.

  8. Smith R, Ronald J, Delaive K, et al. What are obstructive sleep apnea patients being treated for prior to this diagnosis? Chest. 2002;121:164-72.

  9. Ronald J, Delaive K, Roos L, et al. Health care utilization in the 10 years prior to diagnosis in obstructive sleep apnea syndrome patients. Sleep. 1999;22:225-9.

  10. Leger D, Bayon V, Laaban JP, Philip P. Impact of sleep apnea on economics. Sleep Med Rev. 2012;16:455-62.

  11. Schwab RJ. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Am J Respir Crit Care Med. 1997;156:874-80.

  12. Friedman M, Tanyeri H, La Rosa M, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope. 1999;109:1901-7.

  13. Schwab RJ, Gupta KB, Gefter WB, et al. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med. 1995;152:1673-89.

  14. Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C. Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope. 2000;110:1689-93.

  15. Villaneuva AT, Buchanan PR, Yee BJ, Grunstein RR. Ethnicity and obstructive sleep apnoea. Sleep Med Rev. 2005;9:419-36.

  16. Mar J, Rueda JR, Durán J. Análisis Coste-Efectividad de los Tratamientos del Síndrome de la Apnea del Sueño en la Comunidad Autónoma del País Vasco. Investigación Comisionada. Vitoria- Gasteiz. Departamento de Sanidad, Gobierno Vasco, 2000. Informe nº: Osteba D-01-01.

  17. Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med. 1997;127:581-7.

  18. Flemons WW. Clinical practice. Obstructive sleep apnea. N Engl J Med. 2002;347:498-504.

  19. Iber C, Ancoli-Israel, Chesson A, Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events: Rules Terminology and Technical Specifications, 1st ed. Westchester, Illinois: American Academy of Sleep Medicine, 2007.

  20. NucktonT, Glidenn D, Warren S, Claman D. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep. 2006;29:903-8

  21. Seed PT, Tobias A. Stata 2004. Technical Bulletin. 2004;59:9-12.

  22. Jung DG, Cho HY, Grunstein RR, Yee B. Predictive value of Kushida index and acoustic pharyngometry for the evaluation of upper airway in subjects with or without obstructive sleep apnea. J Korean Med Sci. 2004;19:662-7.

  23. Soares MC, de Azeredo Bittencourt LR, Zonato AI, Gregório LC. Application of the Kushida morphometric model in patients with sleepdisordered breathing. Braz J Otorhinolaryngol. 2006;72:541-8.

  24. Will MJ, Ester MS, Ramirez SG, et al. Comparison of cephalometric analysis with ethnicity in obstructive sleep apnea syndrome. Sleep. 1995;18:873-5.

  25. Okubo M, Suzuki M, Horiuchi A, et al. Morphological analyses of mandible and upper airway soft tissue by MRI of patient with obstructive sleep apnea/hypopnea syndrome. Sleep. 2006;29:909-15.

  26. Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: A prospective cohort study. PLoS Med. 2009;6:e1000132.

  27. Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: The Busselton Health Study. Sleep. 2008;31:1079.




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