Identifying the risk of obstructive sleep apnea in metabolic syndrome patients: Diagnostic accuracy of the Berlin Questionnaire

Author(s)

Cepeda, Felipe X. ^{[1, 2]} ; Virmondes, Leslie ^[1] ; Rodrigues, Sara ^[2] ; Dutra-Marques, Akothirene C. B. ^[2] ; Toschi-Dias, Edgar ^{[2, 3]} ; Ferreira-Camargo, Fernanda C. ^[1] ; Hussid, Maria Fernanda ^[1] ; Rondon, Maria Urbana P. B. ^[4] ; Alves, Maria Janieire N. N. ^[2] ; Trombetta, Ivani C. ^[1]

Affiliation

^[1] Univ Nove Julho UNINOVE, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Hosp Clin, Heart Inst InCor, Sao Paulo - Brazil

^[3] Univ Ibirapuera, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Sch Phys Educ & Sports, Sao Paulo - Brazil

• Document type: Journal article
• Source: PLoS One; v. 14, n. 5 MAY 21 2019.
• Web of Science Citations: 0

Abstract

Background Obstructive sleep apnea (OSA) is a risk factor frequently present in patients with metabolic syndrome (MetS). Additionally, moderate and severe OSA are highly prevalent in patients with cardiac disease, as they increase the riskfor cardiovascular events by 80%. The gold standard diagnostic method for OSA is overnight polysomnography (PSG), which remains unaffordable for the overall population. The aim of the present study was to evaluate whether the Berlin Questionnaire (BQ) is anuseful tool for assessing the risk of OSA in patients with MetS. Methods 97 patients, previously untreated and recently diagnosed with MetS (National Cholesterol Education Program, Adult Treatment Panel III, ATP-III) underwent a PSG. OSA was characterized by the apnea-hypopnea index (AHI). BQ was administered before PSG and we evaluated sensitivity, specificity, positive and negative predictive values, and accuracy. Results Of the 97 patients with MetS, 81 patients had OSA, with 47 (48.5%) presenting moderate and severe OSA. For all MetS with OSA (AHI >= 5 events/hour), the BQ showed good sensitivity (0.65, 95% CI 0.54 to 0.76) and fair specificity (0.38, 95% CI 0.15-0.65) with a positive predictive value of 0.84, a negative predictive value of 0.18 and an 84% accuracy. Similarly, for moderate-to-severe OSA (AHI >= 15 events/hour) we found good sensitivity (0.73, 95% CI 0.58-0.85) and fair specificity (0.40, 95% CI 0.27-0.55). Interestingly, for severe OSA (AHI. 30 events/hour), there was a very good sensitivity (0.91, 95% CI 0.72-0.99) and moderate specificity (0.42, 95% CI 0.31-0.54). Conclusion The BQ is a valid tool for screening the risk of OSA in MetS patients in general, and it is particularly useful in predicting severe OSA. (AU)

• FAPESP's process: 15/03274-0 - Diet and exercise improves metabolic, inflammatory changes and sympathovagal balance in patients with metabolic syndrome and obstructive sleep apnea
• Grantee: Felipe Xerez Cepêda Fonseca
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 16/16831-7 - Metabolic/inflammatory markers and sympatho-vagal balance in patients with metabolic syndrome and obstructive sleep apnea: effect of hypocaloric diet and exercise training
• Grantee: Felipe Xerez Cepêda Fonseca
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate
• FAPESP's process: 11/17533-6 - Autonomic, metabolic and inflammatory aspects of metabolic syndrome associated with obstructive sleep apnea: effect of hypocaloric diet and physical training
• Grantee: Ivani Credidio Trombetta
• Support Opportunities: Regular Research Grants
• FAPESP's process: 13/15323-0 - Arterial stiffness and vascular resistance in patients with metabolic syndrome: effect of hypocaloric diet associated with exercise training
• Grantee: Sara Rodrigues
• Support Opportunities: Scholarships in Brazil - Master
• FAPESP's process: 13/07651-7 - Prognostic value of the oscillatory pattern of muscle sympathetic nerve activity in patients with heart failure
• Grantee: Edgar Toschi Dias
• Support Opportunities: Scholarships in Brazil - Post-Doctoral