Sleep Apnea

### Make the Diagnosis: Sleep Apnea

#### Prior Probability of Sleep Apnea

The prevalence of sleep apnea in community-screened patients is 2% to 14% when the diagnosis is established by an apnea-hypopnea index (AHI) ≥ 5/h.1,2 and 3

#### Patients in Whom Sleep Apnea Should Be Considered

Patients with sleep apnea tend to be older patients with a high body mass index (BMI). Family members may report that the patient has habitual, loud, disruptive snoring that can also be associated with choking or gasping and actual episodes of apnea. The patient may recognize none of those symptoms, but he or she may frequently complain of fatigue. Daytime sleepiness is more important than fatigue, and is characterized by situations in which the patient would be expected to exhibit alertness but instead feels sleepy. Fatigue is a generalized sense of weariness.

#### Assessing the Likelihood of Sleep Apnea

Snoring is common in the general population, so as an isolated symptom it has little effect on the likelihood of sleep apnea (positive likelihood ratio [LR], 1.3-1.5). Nocturnal gasping or choking is the only symptom that by itself has an LR+ > 2.0 (see Table 92-1). The absence of apneas is the most useful finding for identifying patients without sleep apnea.

Table 92-1.Accuracy of Findings for Sleep Apnea

Because most individual symptoms or signs lack diagnostic accuracy, physicians usually evaluate patients for combinations of findings. Unfortunately, the physician’s overall impression is not more useful than the individual symptoms or signs (overall clinical impression of sleep apnea: LR+, 1.7; 95% CI, 1.5-2.0; LR- 0.67; 95% CI, 0.60-0.74). The Snoring Severity Scale4 in combination with BMI is most useful for ruling out the likelihood of moderate to severe sleep apnea, but it requires confirmation in additional studies that also assess its accuracy for mild sleep apnea (AHI, 5 to < 15). The Sleep Apnea Clinical Score5 combines the results of 4 findings (snoring, nocturnal gasping or choking, hypertension, and neck circumference) and then uses a grid to determine the score. Like the Snoring Severity Scale, it has been evaluated in only 1 study. However, the Sleep Apnea Clinical Score may be the most useful combination for identifying patients most likely to have sleep apnea (see Table 92-2...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

## Subscription Options

### JAMAevidence Full Site: One-Year Subscription

Connect to the full suite of JAMAevidence content and resources including interactive self-assessment, videos, and more.