OBJECTIVE: To determine the diagnostic sensitivity and specificity and comparative effectiveness of traditional sleep apnea screening tools in traumatic brain injury (TBI) neurorehabilitation admissions.
DESIGN: Prospective diagnostic comparative effectiveness trial of sleep apnea screening tools relative to the gold standard, attended Level 1 polysomnography including encephalography. SETTING: Six TBI Model System Inpatient Rehabilitation Centers PARTICIPANTS: Between 05/2017 and 02/2019, 452 of 896 screened were eligible for the trial with 348 consented (78% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. INTERVENTION: Not applicable. MAIN OUTCOME: Area Under the Curve (AUC) of screening tools relative to total apnea hypopnea index≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (IQR 29-47).
RESULTS: The Berlin high risk score (ROC-AUC=0.63) was inferior to the MAPI (ROC-AUC = 0.7802) (p=.0211, CI: 0.0181, 0.2233) and STOPBANG (ROC-AUC = 0.7852) (p=.0006, CI: 0.0629, 0.2302); both of which had comparable AUC (p=.7245, CI: -0.0472, 0.0678).
FINDINGS were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI>5. The pattern was similar across TBI severity subgroups except for post-traumatic amnesia (PTA) status wherein the MAPI outperformed the Berlin and STOPBANG. Youden's Index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples.
CONCLUSION: This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.
Published by Elsevier Inc.
Language: en
Keywords
Brain Injuries; Comparative Effectiveness Research; Mass Screening; Obstructive; Sensitivity and Specificity; Sleep Apnea; Traumatic