Comparative effectiveness of sleep apnea screening instruments during inpatients rehabilitation following moderate to severe TBI

Model System:

TBI

Reference Type:

Journal article

Accession No.:

J83121

Journal:

Archives of Physical Medicine and Rehabilitation

Year, Volume, Issue, Page(s):

2020 , 101, 2, 283-296

Publication Website:

Abstract:

Study assessed the diagnostic sensitivity and specificity and comparative effectiveness of traditional sleep apnea screening tools in traumatic brain injury (TBI) neurorehabilitation admissions. Potential participants were enrolled in 6 TBI Model System Inpatient Rehabilitation Centers. Between May 2017 and February 2019, 449 of 896 screened were eligible for the trial and 345 consented. Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. The receiving operating curve (ROC) area under the curve (AUC) of the screening tools was estimated relative to total apnea hypopnea index ≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI). The Berlin high-risk score (ROC AUC = 0.634) was inferior to the Multivariable Apnea Prediction Index (MAPI) (ROC AUC = 0.780) and the Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender (STOPBANG) score (ROC AUC = 0.785). 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 posttraumatic amnesia (PTA) status wherein the MAPI outperformed the Berlin. Youden's index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples. 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.

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