Sex-Specific Prediction Models for Sleep Apnea From the Hispanic Community Health Study/Study of Latinos

Chest. 2016 Jun;149(6):1409-18. doi: 10.1016/j.chest.2016.01.013. Epub 2016 Jan 23.


Objective: We developed and validated the first-ever sleep apnea (SA) risk calculator in a large population-based cohort of Hispanic/Latino subjects.

Methods: Cross-sectional data on adults from the Hispanic Community Health Study/Study of Latinos (2008-2011) were analyzed. Subjective and objective sleep measurements were obtained. Clinically significant SA was defined as an apnea-hypopnea index ≥ 15 events per hour. Using logistic regression, four prediction models were created: three sex-specific models (female-only, male-only, and a sex × covariate interaction model to allow differential predictor effects), and one overall model with sex included as a main effect only. Models underwent 10-fold cross-validation and were assessed by using the C statistic. SA and its predictive variables; a total of 17 variables were considered.

Results: A total of 12,158 participants had complete sleep data available; 7,363 (61%) were women. The population-weighted prevalence of SA (apnea-hypopnea index ≥ 15 events per hour) was 6.1% in female subjects and 13.5% in male subjects. Male-only (C statistic, 0.808) and female-only (C statistic, 0.836) prediction models had the same predictor variables (ie, age, BMI, self-reported snoring). The sex-interaction model (C statistic, 0.836) contained sex, age, age × sex, BMI, BMI × sex, and self-reported snoring. The final overall model (C statistic, 0.832) contained age, BMI, snoring, and sex. We developed two websites for our SA risk calculator: one in English ( and another in Spanish (

Conclusions: We created an internally validated, highly discriminating, well-calibrated, and parsimonious prediction model for SA. Contrary to the study hypothesis, the variables did not have different predictive magnitudes in male and female subjects.

Keywords: clinical decision-making; community health; epidemiology (pulmonary); sex-specific prediction; sleep apnea.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Clinical Decision-Making / methods
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Hispanic or Latino
  • Humans
  • Male
  • Models, Statistical
  • Polysomnography* / methods
  • Polysomnography* / statistics & numerical data
  • Prevalence
  • Risk Factors
  • Sex Factors
  • Sleep Apnea Syndromes* / diagnosis
  • Sleep Apnea Syndromes* / ethnology
  • Sleep Apnea Syndromes* / physiopathology
  • United States / epidemiology