O037 Diagnostic Accuracy of OSA Screening Tools for Acute Coronary Syndrome
Sleep advances(2023)
Abstract
Obstructive sleep apnoea(OSA) is associated with cardiovascular diseases including acute coronary syndrome(ACS). Current estimates suggest some 70% of patients with ACS have OSA. OSA in this population remains under-recognised. This high prevalence calls for effective OSA screening tools for this high-risk population. We aimed to assess the diagnostic accuracy of the Epworth Sleepiness Scale (ESS), Berlin and STOP-BANG questionnaire in screening for OSA in patients with ACS. 70 patients with ACS (age IQR: 58[52,63] years, BMI: 27[24,30]kg/m2) were recruited from the cardiology department following an admission for ACS. Patients were administered with the ESS, Berlin and STOP-BANG questionnaires within 6 months of ACS admission. A level 2 polysomnogram was conducted to confirm the presence and severity of OSA (AHI≥5). The diagnostic accuracy of ESS>10, Berlin questionnaire (high-risk category), STOP-BANG score ≥3 (intermediate-high risk) and STOP-BANG score ≥5 (high-risk) was compared to a level 2 polysomnogram for different OSA severity. OSA (AHI≥5 events/h) was diagnosed in 94% of patients with ACS. 67% of patients had moderate-severe OSA (AHI≥15 events/h). ESS, Berlin and STOP-BANG questionnaires have poor diagnostic accuracy across all severity of OSA (ESS>10, AUC:0.60 (95%CI: 0.42-0.79); Berlin, high risk, AUC:0.54 (95%CI: 0.39-0.68); STOP-BANG ≥3, AUC:0.69 (95%CI: 0.56-0.82); STOP-BANG ≥5, AUC: 0.66 (95%CI: 0.53-0.79)). This study confirms a very high prevalence of OSA in patients with ACS. The Berlin and STOP-BANG questionnaires alone are inadequate to identify OSA in this high-risk cohort. Simplified objective measures to screen for OSA may be better suited for this patient population.
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