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The authors attempted to validate a 2-stage strategy to screen for severe obstructive sleep apnea syndrome (s- OSAS) among hypertensive outpatients, with polysomnography ( PSG) as the gold standard. Using a prospective design, outpatients with hypertension were recruited from medical outpatient clinics. Interventions included (1) assessment of clinical data; (2) home sleep testing ( HST); and (3) 12-channnel, in-laboratory PSG. The authors developed models using clinical or HST data alone (single-stage models) or clinical data in tandem with HST (2-stage models) to predict s- OSAS. For each model, area under receiver operating characteristic curves ( AUCs), sensitivity, specificity, negative likelihood ratio, and negative post-test probability ( NPTP) were computed. Models were then rank-ordered based on AUC values and NPTP. HST used alone had limited accuracy ( AUC=0.727, NPTP=2.9%). However, models that used clinical data in tandem with HST were more accurate in identifying s- OSAS, with lower NPTP: (1) facial morphometrics ( AUC=0.816, NPTP=0.6%); (2) neck circumference ( AUC=0.803, NPTP=1.7%); and Multivariable Apnea Prediction Score ( AUC=0.799, NPTP=1.5%) where sensitivity, specificity, and NPTP were evaluated at optimal thresholds. Therefore, HST combined with clinical data can be useful in identifying s- OSAS in hypertensive outpatients, without incurring greater cost and patient burden associated with in-laboratory PSG. These models were less useful in identifying obstructive sleep apnea syndrome of any severity. [ABSTRACT FROM AUTHOR]

The association between obstructive sleep apnea ( OSA) and hypertension by race/ethnicity has not been well characterized in a national sample. Adult participants in the 2007-2008 National Health and Nutrition Examination Survey were reviewed by self-report of sleep apnea diagnosis, snorting, gasping or stopping breathing during sleep, and snoring to derive whether OSA was probable ( pOSA). Multivariable logistic regression determined whether pOSA predicted hypertension in the overall cohort, and by body mass index ( BMI) group and ethno-racial strata. pOSA predicted hypertension in several groups: (1) Within BMI strata, there was a significant association among overweight individuals [odds ratio [ OR], 1.82; 95% confidence interval [ CI], 1.26-2.62); (2) In race/ethnicity subgroups, the association was significant among Hispanic/Latinos ( OR, 1.69; 95% CI, 1.13-2.53) and whites ( OR, 1.40; 95% CI, 1.07-1.84); (3) In models stratified by both race/ethnicity and BMI, pOSA predicted hypertension among overweight black/ African Americans ( OR, 4.74; 95% CI, 1.86-12.03), overweight whites ( OR, 1.65; 95% CI, 1.06-2.57), and obese Hispanic/ Latino participants ( OR, 2.01; 95% CI, 1.16-3.49). A simple, self-report tool for OSA was strongly associated with hypertension, and may serve as a potential future opportunity for OSA diagnosis. [ABSTRACT FROM AUTHOR]