Outside of a perioperative setting, the DES-OSA score seems to be the most effective of the 4 clinical scores for predicting the occurrence of hypoxemic episodes in patients with severe obstructive sleep apnea (OSA), according to the results of a prospective study (ClinicalTrials.gov Identifier: NCT02050685) conducted at Clinique Saint-Luc in Bouge, Belgium, and published by PLoS One.
Currently, 4 clinical scores are used to detect OSA in patients preoperatively: STOP-Bang, P-SAP, OSA50, and DES-OSA. The study investigators sought to compare the ability of these 4 scores to specifically detect patients with hypoxemic severe OSA.
A total of 159 patients who were scheduled to undergo an overnight polysomnography were prospectively enrolled in the study. Mean patient age was 55.8±14.0 years; 68% were men.
The ability of the 4 clinical scores to predict the occurrence of hypoxemic episodes in patients with severe OSA was compared by using sensitivity, specificity, Youden Index, Cohen kappa coefficient, and area under the ROC curve analyses.
OSA50 had the highest sensitivity for detecting patients with hypoxemia (1.00; 95% CI, 0.89-1.00) and was significantly more sensitive than STOP-Bang. DES-OSA was significantly more specific (0.58; 95% CI, 0.49-0.66) than the other 3 clinical scores. The Youden Index of DES-OSA (0.45; 95% CI, 0.38-0.53) was significantly higher than the STOP-Bang, OSA50, and P-SAP scores. The area under the ROC curve of DES-OSA was significantly the largest (0.8; 95% CI, 0.71-0.89). DES-OSA was associated with the highest Kappa value (0.33; 95% CI, 0.21-0.45), which was significantly higher than the OSA50 and STOP-Bang scores.
The investigators concluded that although the DES-OSA seemed to be more efficient than the other 3 clinical scores at detecting hypoxemia in patients with severe OSA, prospective studies are warranted in order to confirm these findings in a perioperative setting. Identifying these patients is clinically relevant, since they are most likely at high risk for postoperative complications.
Deflandre E, Piette N, Bonhomme V, et al. Comparison of clinical scores in their ability to detect hypoxemic severe OSA patients. PLoS One. 2018;13(5):e0196270.