A new tool to screen patients with severe obstructive sleep apnea in the primary care setting: a prospective multicenter study

BMC Pulm Med. 2022 Jan 15;22(1):38. doi: 10.1186/s12890-022-01827-0.


Background: The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting.

Methods: Anthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the β coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed.

Results: 194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763-0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% ≥ 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863-0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7-92.1) and specificity of 67.8% (95% CI 55.1-78.3).

Conclusions: The use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment. Clinical Trial Registration Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: https://clinicaltrials.gov/ct2/show/NCT02591979 ; Identifier: NCT02591979. Date of registration: October 30, 2015.

Keywords: Continuous positive airway pressure (CPAP); Home sleep apnea test; Obstructive sleep apnea; Primary healthcare; Screening model; Sleep unit.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Continuous Positive Airway Pressure
  • Diagnostic Techniques and Procedures*
  • Female
  • Health Status Indicators*
  • Humans
  • Male
  • Middle Aged
  • Polysomnography
  • Primary Health Care
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / therapy
  • Spain
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT02591979