A decision rule for diagnostic testing in obstructive sleep apnea

Am J Respir Crit Care Med. 2003 May 15;167(10):1427-32. doi: 10.1164/rccm.200112-110OC. Epub 2003 Jan 24.


Obstructive sleep apnea (OSA) is traditionally diagnosed using overnight polysomnography. Decision rules may provide an alternative to polysomnography. A consecutive series of patients referred to a tertiary sleep center underwent prospective evaluation with the upper airway physical examination protocol, followed by determination of the respiratory disturbance index using a portable monitor. Seventy-five patients were evaluated with the upper airway physical examination protocol. Historic 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 over-bite. A decision rule was developed using three predictors: a cricomental space of 1.5 cm or less, a pharyngeal grade of more than II, and the presence of overbite. In patients with all three predictors (17%), the decision rule had a positive predictive value of 95% (95% confidence interval [CI], 75-100%) and a negative predictive value of 49% (95% CI, 35-63%). A cricomental space of more than 1.5 cm (27% of patients) excluded OSA (negative predictive value of 100%, 95% CI, 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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Anthropometry
  • Female
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic / instrumentation
  • Monitoring, Physiologic / methods*
  • Pharynx / anatomy & histology
  • Pharynx / physiology
  • Physical Examination / methods
  • Polysomnography / methods
  • Predictive Value of Tests
  • Prospective Studies
  • Reproducibility of Results
  • Risk Factors
  • Sampling Studies
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / epidemiology