Validation of five different questionnaires for identifying sleep apnea syndrome in a sleep clinic

Background: Different clinical models and questionnaires have been used for the identification of patients with the highest probability for Obstructive Sleep Apnea/hypopnea Syndrome (OSAHS). Objectives: To evaluate the clinical utility of five different questionnaires: Stop, Stop Bang (S-B), Berlin (BQ), Epworth Sleepiness Scale (ESS) and 4 Variable Screening Tool (4-V) in a Sleep Clinic and to assess the best possible combination of these tools. Methods: A retrospective study of 1853 (74.4% males) patients (mean age 52 ±14 years, BMI 32.8±7 kg/m 2 ) visiting a sleep clinic who answered the 5 questionnaires and underwent polysomnography. Results: S-B had the highest sensitivity (97.6%), the highest area under the ROC curve (AUC) (0.73, 95%CI 0.7-0.76) and best OR (5.9, 95%CI 3.6-9.5), but the lowest specificity (12.7%) for AHI≥15. The 4-V≥14 had the highest specificity (74.4%) followed by ESS (67%). BQ had good sensitivity (87%), worse specificity (33%) than 4-V and ESS but better than Stop (13%) and S-B (12.7%). The combined sensitivities and specificities for the S-B and 4-V, ESS and S-B, ESS and BQ, BQ and 4-V, S-B, ESS and BQ did not improve the predictive values. Conclusions: S-B had the highest sensitivity, OR and AUC but rather low specificity and 4-V the highest specificity. The combination of different questionnaires did not improve their predictive value.