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VOLUME 35, ISSUE 11

IN-HOME, SELF-ASSEMBLED SLEEP STUDIES FOR DIAGNOSING SLEEP APNEA IN ELDERLY
In-Home, Self-Assembled Sleep Studies Are Useful in Diagnosing Sleep Apnea in the Elderly

http://dx.doi.org/10.5665/sleep.2196

Christian R. Morales, MD1; Sharon Hurley, BA1; Lindsay C. Wick, MS, MPE1; Bethany Staley1; Frances M. Pack1; Nalaka S. Gooneratne, MD, MSc1,2,3; Greg Maislin, MS, MA1; Allan Pack, MD, PhD1,2; Indira Gurubhagavatula, MD, MPH1,2,4

1Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; 2Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; 3Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; 4Pulmonary and Critical Care and Sleep Section, Philadelphia VA Medical Center, Philadelphia, Pennsylvania



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Objectives:

Obstructive sleep apnea (OSA) is common and treatable among the elderly. Yet, few older adults seek evaluation for OSA at sleep disorders centers. The authors assessed the feasibility of a two-stage screening procedure for obstructive sleep apnea syndrome (OSAS) in a community-based sample of older adults.

Design:

Prospective cohort study.

Setting:

Participants' domicile (in-home) and academic sleep research center.

Participants:

There were 452 Medicare recipients residing in the greater Philadelphia metropolitan area with the complaint of daytime sleepiness.

Interventions:

None.

Measurements and Results:

All participants underwent in-home unattended sleep studies that recorded airflow, and standard in-laboratory polysomnography. Additional measures included symptoms of sleep apnea, body mass index, neck circumference, age, and sex. When comparing diagnostic approaches, the best-performing single-stage model was one that combined apnea symptoms with age and neck circumference. This model had an area under the receiver operating characteristic curve (AUC) of 0.774 and negative posttest probability of 1.2%. The best-performing two-stage model combined symptoms, neck circumference, age, and sex in the first stage, followed by an unattended portable study with a corresponding AUC of 0.85 and negative posttest probability of 0.5%.

Conclusions:

Unattended, self-assembled, in-home sleep studies recording airflow and respiratory effort are most useful if applied in tandem with clinical data, including a carefully obtained sleep history. This two-stage model is accurate in identifying severe OSAS in older adults and represents a practical diagnostic approach for older adults. Incorporating clinical data was vital and increased accuracy well above that of unattended studies of airflow and effort alone.

Citation:

Morales CR; Hurley S; Wick LC; Staley B; Pack FM; Gooneratne NS; Maislin G; Pack A; Gurubhagavatula I. In-home, self-assembled sleep studies are useful in diagnosing sleep apnea in the elderly. SLEEP 2012;35(11):1491-1501.

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