Validation of the Epworth Sleepiness Scale, Berlin, STOP-Bang Questionnaires and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Patients With Chronic Obstructive Pulmonary Disease, Asthma, and Cardiovascular Diseases

Hamdy Mahmoud, DM; Suzan Sallma, MD; Azza Mohammad, MD

PURPOSE: Obstructive sleep apnea (OSA) is a common medical condition and may lead to life threatening problems if it is left undiagnosed. Polysomnographyis the ‘‘gold standard’’ for OSA diagnosis; however, it is expensive and not widely available. This study was conducted to evaluate the Epworth Sleepiness Scale (ESS) ,Berlin, STOP-Bang questionnaires and the American Society of Anesthesiologists (ASA) checklist for screening OSA in patients with COPD, asthma and CVD.

METHODS: The study was performed on 180 patients, 60 COPD,60 asthmatics and 60 patients with CVD without previously diagnosed OSA were recruited Subjects completed the Questionnaires. The scores from the ESS, Berlin, STOPBANG questionnaires,and ASA checklist were evaluated.

RESULTS: In the COPD, asthma& CVD groups, the mean ages were 61.5±4.8 (80% male),45.6±7.1 (47%male)and 58.8±8.5 (78.3%male)respectively. Of 180 screened patients, (30, 70, 20and15% of COPD), (32,55,37,&35% of asthmatic) and (70,35,60 &49% of CVD) were respectively classified as being at high risk of OSA by the ESS,STOP BANG, Berlin questionnaires, and ASA checklist.The risk of OSA increased up to age 65 years. A significant number of obese individuals (58%) were at high risk for OSA. Those whose questionnaire scores indicated a high risk for OSA were more likely to report subjective sleep problems, a negative impact of sleep on quality of life, and a chronic medical condition than those who were at lower risk. The ESS score was highly significant in the cardiac patients in comparison to the COPD and asthmatic patients. The Berlin questionnaire show very high risk among the cardiac patients followed by the COPD patients and lastly the asthmatic patients.in STOPBANG questionnaire demonstrate significant difference between the cardiac patients with the COPD and asthmatic patients existed. ASA checklist show high risk among the cardiac, asthmatic and COPD.

CONCLUSIONS: Berlin & STOP-Bang Questionnaires are quite reliable to determine which patient need further evaluation of OSA followed by ASA checklist then ESS,STOP and STOP-Bang questionnaires for screening of OSA in the surgical population are suggested due to their higher methodological quality and easy to-use features.

Chest. 2014;146(4_MeetingAbstracts):944A. doi:10.1378/chest.1974389