Screening for Obstructive Sleep Apnea in Patients With MS

The STOP-Bang Questionnaire may be an effective tool in screening patients with multiple sclerosis for moderate to severe obstructive sleep apnea (OSA), although the questionnaire may not sufficiently exclude mild OSA, according to study results published in the Multiple Sclerosis Journal.

Although consequential and prevalent in patients with multiple sclerosis, OSA is often underdiagnosed in this population. To help improve screening for OSA in patients with multiple sclerosis, a team of investigators utilized the STOP-Bang Questionnaire, an 8-item instrument often used as a screening tool (validated against overnight polysomnography) for OSA in patients without multiple sclerosis. The goal of the present study was to determine whether STOP-Bang was also valid in screening for OSA in patients with multiple sclerosis.

A total of 200 patients (mean age, 48.8 years; women, 69%; White, 85%) with multiple sclerosis were included in the analysis. Study researchers collected data from 124 people from an ongoing, single-center, randomized controlled trial (ClinicalTrials.gov Identifier: NCT02544373) and collected data from 76 people who were clinic patients.

Findings indicated a polysomnography-confirmed diagnosis of OSA in 78% of patients (mild, 39%; moderate, 21.5%; severe, 17.5%). The median time lapse between the STOP-Bang screening and the overnight polysomnography was 0 days for trial patients and 55.5 days for clinical patients.

The observed STOP-Bang scores (between 0 to 8), ranged from 0 to 7 among the study participants, with approximately 70% of individuals reporting a score of 3 or higher and 26% of participants reporting a score of 5 or higher. For a threshold STOP-Bang score of 3 or higher, apnea-hypopnea index levels of 5 or greater, 15 or greater, and 30 or greater were linked with specificities of 57%, 43%, and 36%, respectively. The same threshold had 87% sensitivity for detecting moderate OSA and 91% sensitivity for detecting severe OSA; however, sensitivity for detecting milder OSA was 76%. The negative-predictive value to identify people without milder forms of OSA was 40%.

The study authors noted that “the sensitivity of this instrument to detect patients with milder forms of OSA was less robust, and the [negative-predictive value] of the STOP-Bang to correctly classify persons without mild OSA was poor.”

“Our findings support the use of the STOP-Bang as an effective tool to screen for moderate and severe OSA in [people with multiple sclerosis] and suggest that providers should consider incorporating this tool into clinical practice. As the reduced ability of the STOP-Bang to exclude mild OSA may reflect in part the high prevalence of OSA in this sample, decisions regarding the need for OSA evaluations in patients with low STOP-Bang scores should be governed by clinical judgment,” concluded the study researchers.

Reference

Singh M, Gavidia R, Dunietz GL, et al. Validation of an obstructive sleep apnea symptom inventory in persons with multiple sclerosis. Mult Scler. Published online May 28, 2021. doi:10.1177/13524585211013014