204
Screening Questionnaires
Several questionnaires and clinical prediction rules have been developed to aid in
the diagnosis of OSA. The most commonly employed of these is the Epworth
Sleepiness Scale (ESS) [ 46 ], an eight-item score in which patients rate their subjec-
tive sleepiness during everyday activities, with a score of 10 and above consistent
with excessive sleepiness. Others include the Stanford Sleepiness Scale, the Berlin
Questionnaire, and the STOP-BANG which was initially validated in perioperative
patients. Although the ESS and other measures have been shown to correlate signifi-
cantly with objective measures of sleepiness, test accuracy is variable across popu-
lations. Furthermore, their false-negative rates are unacceptably high, such that
reliance on these tests alone is likely to lead to significant underdiagnosis of obstruc-
tive sleep apnea [ 47 , 48 ].
Table 13.2 Clinical
characteristics suggestive of
obstructive sleep apnea
(OSA)
Clinical characteristics
Male sex
Postmenopausal females
Overweight, especially if central
adiposity
History of cardiovascular disease
Nighttime symptoms
Witnessed apneas
Loud, frequent snoring
Dry mouth
Nocturia
Awakening from sleep with choking,
gasping, or dyspnea
Night sweats
Daytime symptoms
Excessive daytime sleepiness
Daytime fatigue
Concentration difficulties
Morning headaches
Physical examination
Neck circumference > 16′′ in women
and >17′′ in men
Upper airway anatomic
abnormalities (enlarged tonsils/
uvula, macroglossia)
Retrognathia
Signs of right heart failure (lower
extremity edema)L.A. Tobias and F. Roux