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Published ahead of print on January 24, 2003, doi:10.1164/rccm.200112-110OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 10, May 2003, 1427-1432

A more recent version of this article appeared on May 15, 2003
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Submitted on December 4, 2001
Accepted on January 16, 2003

A Decision Rule for Diagnostic Testing in Obstructive Sleep Apnea

Willis H Tsai1*, John E Remmers1, Rollin Brant2, W. Ward Flemons1, Jan Davies3, and Colin Macarthur2

1 Medicine, University of Calgary, Calgary, Alberta, Canada, 2 Community Health Sciences, University of Calgary, Calgary, Alberta, Canada, 3 Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada

* To whom correspondence should be addressed. E-mail: tsai{at}ucalgary.ca.

Obstructive sleep apnea (OSA) is traditionally diagnosed using overnight polysomnography (PSG). Decision rules may provide an alternative to PSG. A consecutive series of patients referred to a tertiary sleep centre underwent prospective evaluation with the Upper Airway Physical Examination Protocol (UAPP), followed by determination of the respiratory disturbance index using a portable monitor. Seventy-five patients were evaluated with the UAPP. Historical predictors included age, snoring, witnessed apneas, and hypertension. Physical examination-based predictors included: body mass index, neck circumference, mandibular protrusion, thyro-rami distance, sterno-mental distance, sterno-mental displacement, thyro-mental displacement, cricomental space, pharyngeal grade, Sampsoon-Young classification, and overbite. A decision rule was developed using 3 predictors: cricomental space <= 1.5 cm, pharyngeal grade >II, and the presence of overbite. In patients with all 3 predictors (17%), the decision rule had a positive predictive value of 95% (CI95%: 75-100%) and a negative predictive value of 49% (CI95%: 35-63%). A cricomental space > 1.5 cm (27% of patients) excluded obstructive sleep apnea (negative predictive value: 100% (CI95%: 75-100%)). Comparable performance was obtained in a validation sample of 50 patients referred for diagnostic testing. This decision rule provides a simple, reliable, and accurate method of identifying a subset patients with, and perhaps more importantly, without OSA.
Key words: obstructive sleep apnea, decision rule, diagnostic testing, physical examination




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