Obstructive Sleep Apnea Screening with a 4-Item Instrument, Named GOAL Questionnaire: Development, Validation and Comparative Study with No-Apnea, STOP-Bang, and NoSAS
Received 12 November 2019
Accepted for publication 14 January 2020
Published 23 January 2020 Volume 2020:12 Pages 57—67
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Steven A Shea
Ricardo LM Duarte,1,2 Flavio J Magalhães-da-Silveira,1 Tiago S Oliveira-e-Sá,3,4 Joana A Silva,5 Fernanda CQ Mello,2 David Gozal6
1Sleep - Laboratório de Estudo dos Distúrbios do Sono, Centro Médico BarraShopping, Rio de Janeiro, Brazil; 2Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; 3Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisbon, Portugal; 4NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; 5Clínica São Vicente, Rede D’Or, Rio de Janeiro, Brazil; 6Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
Correspondence: David Gozal
Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
Background: Obstructive sleep apnea (OSA) is a very prevalent disorder. Here, we aimed to develop and validate a practical questionnaire with yes-or-no answers, and to compare its performance with other well-validated instruments: No-Apnea, STOP-Bang, and NoSAS.
Methods: A cross-sectional study containing consecutively selected sleep-lab subjects underwent full polysomnography. A 4-item model, named GOAL questionnaire (gender, obesity, age, and loud snoring), was developed and subsequently validated, with item-scoring of 0– 4 points (≥ 2 points indicating high risk for OSA). Discrimination was assessed by area under the curve (AUC), while predictive parameters were calculated using contingency tables. OSA severity was classified based on conventionally accepted apnea/hypopnea index thresholds: ≥ 5.0/h (OSA≥ 5), ≥ 15.0/h (OSA≥ 15), and ≥ 30.0/h (OSA≥ 30).
Results: Overall, 7377 adults were grouped into two large and independent cohorts: derivation (n = 3771) and validation (n = 3606). In the derivation cohort, screening of OSA≥ 5, OSA≥ 15, and OSA≥ 30 revealed that GOAL questionnaire achieved sensitivity ranging from 83.3% to 94.0% and specificity ranging from 62.4% to 38.5%. In the validation cohort, screening of OSA≥ 5, OSA≥ 15, and OSA≥ 30, corroborated validation steps with sensitivity ranging from 83.7% to 94.2% and specificity from 63.4% to 37.7%. In both cohorts, discriminatory ability of GOAL questionnaire for screening of OSA≥ 5, OSA≥ 15, and OSA≥ 30 was similar to No-Apnea, STOP-Bang or NoSAS.
Conclusion: All four instruments had similar performance, leading to a possible greater practical implementation of the GOAL questionnaire, a simple instrument with only four parameters easily obtained during clinical evaluation.
Keywords: obstructive sleep apnea, polysomnography, screening, questionnaire, diagnosis
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