Sleep apnoea screening tool ‘holds promise’

A newly devised nine-step screening tool could allow GPs to identify more patients with obstructive sleep apnoea (OSA), its developers believe.
 
In an article published in the Medical Journal of Australia this week, researchers said using the tool, known as the General Practice Sleep Scale (GPSS) may help counter a low case detection rate of OSA.
 
They write that their new tool ‘holds promise’ and describe existing OSA screening tools as ‘either too time-consuming or too narrowly focused’.

‘Moreover, primary care physicians are burdened with competing priorities and time constraints,’ the article states.
 
‘Consequently, primary care clinicians can often underutilise these existing OSA screening tools, resulting in missed opportunities for diagnosis and intervention for OSA.’
 
The simplified questionnaire covers age, BMI, neck circumference, snoring, tiredness, as well as prevalence of high blood pressure, diabetes, heart disease and depression.
 
Professor Nick Zwar, a GP with a special interest in sleep, believes there is merit in simplifying questionnaires for referrals, but said more research was needed.
 
‘It’s a good study, but it is from one centre and is a fairly small number of people,’ he told newsGP.
 
Earlier this year, the researchers wrote an article for the Sleep Medicine journal detailing the results of the tool’s use among 159 patients in the Northern Territory.
                                                                                                                                                                       
It indicates the GPSS ‘significantly outperformed’ screening tools including the Epworth Sleepiness Scale, Berlin questionnaire and OSA-50. It was also described as ‘comparable but slightly improved’ against the STOP-Bang screening tool.
 
However, for Professor Zwar, who led the development of a suite of primary care sleep resources for the Australasian Sleep Association, its usefulness for GPs is yet to be reliably shown.
 
He noted the study included patients who had already been referred to a sleep clinic.
 
‘Whether that reflects what you’d find if you were a GP, using this in practice, in terms of its ability to accurately detect people with sleep apnoea, we just don’t know,’ Professor Zwar said.
 
‘That study is yet to be done.’
 
In the MJA article, the authors acknowledge that ‘as with any new tool, further external validation is essential’.
 
They noted too that the tool’s specificity was lower but said this ‘is expected and acceptable in a screening context where the goal is not to miss at-risk individuals’. 
 
‘Nonetheless, the initial findings are encouraging: the GPSS may offer a more efficient, accurate and feasible way to identify OSA risk in primary care than any existing alternative,’ they wrote.
 
Professor Zwar said more remains to be done before GPs can take it up more widely.
 
‘This scale at the moment wouldn’t qualify people for a Medicare-rebated sleep study,’ he said.
 
‘That’s not surprising, they’re only just developing it. But it’s not ready for widespread use, because one of the key reasons we need to do the questionnaires is to work out eligibility for a rebated study.’
 
According to the Australian Institute of Health and Welfare, sleep disorders occur in more than one in five adults (22%) with OSA more common among those aged 45 and older.
 
Earlier this year, a new sleep health consensus statement was published, urging the Federal Government to make sleep more of a priority.
 
A recent newsGP poll also found that more respondents prioritise discussions about exercise or diet than sleep health.
 
An article published last year in the Australian Journal of General Practice suggests that patients who are asymptomatic or who have mild symptoms ‘might not benefit from medical treatment apart from management of their risk factors’.
 
However, it noted that untreated OSA ‘can have major adverse effects on health and wellbeing and is associated with negative health outcomes such as increased risks of CVD, cognitive decline, motor vehicle accidents … and depression’.
 
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