Published ahead of print on May 13, 2004, doi:10.1164/rccm.200307-968OC Am. J. Respir. Crit. Care Med., Volume 170, Number 4, August 2004, 371-376 A more recent version of this article appeared on August 15, 2004
Submitted on July 20, 2003 Occupational Screening for Obstructive Sleep Apnea in Commercial DriversIndira Gurubhagavatula1*,1 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA; Division of Sleep Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA; Pulmonary and Critical Care and Sleep Section, Philadelphia VA Medical Center, Philadelphia, PA, USA, 2 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA; Division of Sleep Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA * To whom correspondence should be addressed. E-mail: gurubhag{at}mail.med.upenn.edu.
Excluding the presence of obstructive sleep apnea in commercial drivers is valuable, as the syndrome may increase their risk of sleepiness-related accidents. Using polysomnography as the criterion standard, we prospectively compared accuracies of five strategies in excluding the presence of severe sleep apnea and secondarily, any sleep apnea among 406 commercial drivers. These were: 1) symptoms, 2) body mass index 3) symptoms plus body mass index, 4) a two-stage approach with symptoms plus body mass index in everyone, followed by oximetry in a subset, and 5) oximetry in all. For excluding severe apnea, the two-stage strategy was highly successful, with 91% sensitivity and specificity, and a negative likelihood ratio of 0.10. This strategy was comparable in accuracy to oximetry, which had a negative likelihood ratio of 0.12, and was 88% sensitive and 95% specific. If we avoided oximetry altogether, then symptoms together with body mass index were 81% sensitive and 73% specific, with a negative likelihood ratio of 0.26. On the other hand, excluding any apnea could not be done with reasonable accuracy unless oximetry was used. We conclude that two-stage screening is likely to be a viable means of excluding severe sleep apnea among commercial drivers. Key words: polysomnography, nocturnal pulse oximetry, questionnaire
This article has been cited by other articles:
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
