After careful consideration, the American Thoracic Society canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from May 15-20, because of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting. A virtual event is being planned for later this year.
In terms of screening for obstructive sleep apnea (OSA) in people living with HIV, the STOP-BANG questionnaire had good sensitivity, whereas the Berlin questionnaire and the Epworth Sleepiness Scale demonstrated good specificity, according to the results of a study intended to be presented at the American Thoracic Society (ATS) International Conference. (Select research is slated to be presented in a virtual format later this year.)
Previous research has demonstrated that OSA may be common in people with HIV, however, as a result of overlapping symptoms of fatigue and cardiac disease, the true prevalence is unknown. Moreover, the well-known risk factors associated with OSA may not be applicable to the population with HIV. Because the Epworth Sleepiness Scale, Berlin questionnaire, and STOP-BANG questionnaire are commonly used OSA screening tools, researchers aimed to evaluate the validity of these tools for people with HIV.
For this currently ongoing study, researchers have a target cohort of 120 adult men and women with HIV who have viral suppression, and a body mass index between 20 and 35 kg/m2. Participants receive a physical examination, and complete questionnaires prior to undergoing a baseline polysomnography at a research sleep laboratory, with scoring performed using the Chicago and Medicare criteria.
Thus far, 56 participants have been evaluated, of whom 70% were diagnosed with OSA using the Chicago criteria and 52% using the Medicare criteria. The presence of OSA was associated with positive Berlin questionnaires (>2 positive categories) and positive STOP-BANG questionnaire results (score >3), but positivity on the Epworth Sleepiness Scale was not. Further, the sensitivity of a positive STOP-BANG questionnaire was 79.5% with Chicago criteria and 82.8% with Medicare criteria, compared with 38.5% and 44.8%, respectively for the Berlin questionnaire and 41.0% and 44.8%, respectively, for the Epworth Sleepiness Scale.
Conversely, the STOP-BANG questionnaire demonstrated lower specificity (70.6% with Chicago criteria and 55.6% with Medicare criteria), whereas the Berlin questionnaire had specificities of 88.2% and 85.2%, respectively and the Epworth Sleepiness Scale had specificities of 82.4% and 77.8%, respectively.
Investigators highlighted that “ongoing research will help determine whether different cutoffs for these conventional sleep questionnaires or additional screening tools are essential for obstructive sleep apnea screening in people living with HIV.”
Bosompra NA, Orr JE, DeYoung PN, et al. Validating sleep questionnaires in people living with HIV: STOP-BANG outperforms the Berlin questionnaire and Epworth Sleepiness Scale for identifying obstructive sleep apnea. Am J Respir Crit Care Med. 2020;201:A4155.