64 MJA 211 (2) ▪ 15 July 2019 meet the Medicare criteria, meet the however, clinically patients with relevant half the OSA do not scores, and, if the result indicatesahighpre- scores, and,if the screening, but of cost sensitivity. at the screening, of specificity the increases sleepiness, at moderate least daytime of at score 8, least indicating scale Epworth sleepiness of an rion 8 or more. Berlin QuestionnaireanEpworth highriskscore)with scoreof of atleast 4(oranOSA- benchmark combinationofa STOP- the cess for polysomnography sleep studies, screening and sets as the screening by carephysicians primary direct referral inthe pro- (MBS) provisions. Itnow recommendsusingquestionnaires for Schedule to amenditsMedicareBenefits Department ofHealth light,itisinterestingIn this to notedecisionby the Australian the sleep. during a study of breathing case, this in testing; diagnostic followed mustsult be by specific re apositive so screening features, of both combination rigorous as STOP- proach might be to employ a high sensitivity questionnaire (such absence ofbetterscreeningtools, amorebalancedap- In the investigation for many OSA. people with for limitations,andmay their therefore reduceaccessto clinical malise pre- common andproblematiccondition.Theattempt this with to for diagnosis and treatment for a substantial proportion of patients rates. positive false to high sensitivity, leading high achieve values that low at cut- disappointingly is tools similar and questionnaire STOP- of the positives). (false ple readily too specificity The peo healthy in to avoid ruling at moderate is least as specificity out negatives), (false ruled not inappropriately are condition the people with that to ensure required is out, sensitivity point high authors the As questionnaires. screening elusive when using appears specificity and of adequate sensitivity combination The screening, letalonefor diagnosing,OSA. (Senaratna). David R Hillman R David and specificity Screening for sleep apnoea: achieving both sensitivity 1 Sir Charles Gairdner Hospital, Perth, WA. WA. Perth, Hospital, Gairdner Charles Sir Editorial patients of treatment and diagnosis timely hinder may criteria Medicare 2,3 Senaratna and colleagues found that adding the crite the adding that found colleagues and Senaratna Bang with a threshold value athreshold Bang with of3) 4 test screeningbasedonquestionnaires fails to account As the study As the by Senaratna and colleagues indicates, 1,2 50 questionnaire scoreofat least 5ora T 1 mary care. mary obstructive sleepapnoea(OSA) inpri- the limitationsofquestionnairesthe for administrators becauseitillustrates valuable for care providers health and study by Senaratna and colleagues is sions for pre- care, given new Medicare provi the - for contemporary Australian health so they may be a roadblock to timely 2 Centre for Sleep Science, University of Western Australia, Perth, WA. WA. Perth, Australia, Western of Science, University Sleep for Centre questionnaires in screening for timely analysis value of the of his issue of the 1 Ithasparticularrelevance Bang questionnaire score test OSA screening. The 1 Diagnosis demands a demands Diagnosis 2 without Epworth without test probability of MJA includes a Bang Bang off off - - - - OSA, to addlow cost diagnostic testing to increasespecificity. proportion ofpatients. 4 test) accurately moderate identified to severe OSA inahigh combinationofquestionnairethe andovernight oximetry (alevel two- © 2019 AMPCo Pty Ltd Pty AMPCo © 2019 Provenance Competing interests OSA.severe more with patients in tools, particularly diagnostic useful are state), devices sleep including parameters, it similar and other many level assesses polysomnography 1laboratory (which also gold of the standard, that not match does its performance While manner. portable highly asimple,uration) and in inexpensive, oxygen sat arterial and (airflow parameters respiratory records judged. was device The questionnaires of the performance the which against standard diagnostic the as device testing sleep home employed ApneaLink colleagues an his and Senaratna testing, of low diagnostic question cost Relevant to the investigated. further should be specificity and of sensitivity combination simple home- from data with responses questionnaire value of combining The polysomnography. available readily to more less expensive, without recourse tients pa many in of OSA quantified severity to be the made and to be diagnoses allow devices these result, tive questionnaire diagnosis remains unclear — is worth pursuing. worth —is unclear remains diagnosis which in for cases polysomnography reserved with diagnosis, home- by followed response) asimple by the (if indicated of disease possibility the in for ruling sensitivity high with questionnaire years agoby United Medicareinthe States. rejected by Australian the butadopted DepartmentofHealth, 10 cost levels 3and4diagnostic testing for OSA, ameasurehitherto regard,In this MBSsubsidisinglow itistimeto reconsiderthe step approachinAustralian carehasbeenreported: primary based sleep study to increase specificity and to confirm to confirm and specificity study to increase sleep based : Commissioned; externally peer reviewed. peer externally Commissioned; : 6 8 Combined with clinical evaluation and aposi evaluation and clinical with Combined However, —a approach to astaged diagnosis [email protected] : No relevant disclosures. relevant No : based devices for achieving a reasonable areasonable for achieving devices based 7 doi: ▪doi: 10.5694/mja2.50242 ■ 5,6 Theutilityofsucha See Research Research ▪See 3 - - -
Editorial
1 Senaratna CV, Perret JL, Lowe A, et al. Detecting sleep apnoea syndrome in 5 Centers for Medicare and Medicaid Services (United States). Decision memo primary care with screening questionnaires and the Epworth sleepiness scale. for sleep testing for obstructive sleep apnea (OSA) (CAG-00405N). Mar 2009. Med J Aust 2019; 210: 65–71. https://www.cms.gov/medicare-coverage-database/details/nca-decision- 2 Boynton G, Vahabzadeh A, Hammoud S, et al. Validation of the STOP-BANG memo.aspx?NCAId=227&ver= (viewed Mar 2019). questionnaire among patients referred for suspected obstructive sleep apnea. 6 El Shayeb M, Topfer LA, Stafinski T, et al. Diagnostic accuracy of level 3 J Sleep Dis 2013; 2: doi: 10.4172/2325-9639.1000121. portable sleep tests versus level 1 polysomnography for sleep-disordered 3 Douglas JA, Chai-Coetzer CL, McEvoy D, et al. Guidelines for sleep studies in breathing: a systematic review and meta-analysis. CMAJ 2014; 186: adults: a position statement of the Australasian Sleep Association. Sleep Med E25–E51. 2017; 36 (Suppl 1): S2–S22. 7 Chai-Coetzer CL, Antic NA, Rowland LS, et al. A simplified model of screening 4 Medicare Benefits Schedule Review Taskforce. Final report from the Thoracic questionnaire and home monitoring for obstructive sleep apnoea in primary Medicine Clinical Committee. Canberra: Department of Health, 2016. http:// care. Thorax 2011; 66: 213–219. www.health.gov.au/internet/main/publishing.nsf/content/C195FC32CB 8 Pereira EJ, Driver HS, Stewart SC, Fitzpatrick MF. Comparing a combination of 2DBAD6CA25801800175428/$File/MBS%20Thoracic%20Report%20FIN validated questionnaires and level III portable monitor with polysomnography AL.pdf (viewed Mar 2019). to diagnose and exclude sleep apnea. J Clin Sleep Med 2013; 9: 1259–1266. ■ MJA 211 (2) MJA 211 (2) ▪ 15 July 2019
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