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Performance of NoSAS score versus Berlin questionnaire for screening obstructive sleep apnoea in patients with resistant hypertension

Journal of Human Hypertension volume 32, pages 518–523 (2018)Cite this article

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Abstract

Obstructive sleep apnoea (OSA) is the main secondary form associated with resistant hypertension (RH), but it is largely underdiagnosed and consequently undertreated in clinical practice. The Berlin questionnaire (BQ) is a useful tool among general population, but seems to not perform well among patients with RH. Recently, NoSAS score was validated in a large population, however, has not been tested in the cardiovascular scenario. Thus, we aimed to compare BQ versus the NoSAS score as screening tools for OSA in RH. In the present study, patients with confirmed diagnosis of RH were invited to perform polysomnography. OSA was diagnosed by an apnoea-hypopnoea index (AHI) ≥15 events/h. BQ and NoSAS were applied in a blinded way. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) of the two sleep questionnaires to detect OSA in RH. The frequency of OSA was 64%. The BQ presented a better sensitivity (91 vs. 72%) and higher values of NPV (67 vs. 54%) than NoSAS score. In contrast, the NoSAS score had higher specificity for excluding OSA (58 vs. 33%) and higher PPV (75 vs. 70%). Compared to the BQ, NoSAS score had a better AUC (0.55 vs. 0.64) but these values are in the fail to poor accuracy range. In conclusion, both BQ and NoSAS score had low accuracy for detecting OSA in RH. Considering the high frequency of OSA, objective sleep study may be considered in these patients.

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Acknowledgements

We thank Fundação de Amparo à Pesquisa do Estado de São Paulo and Fundação Zerbini for funding research support. We also thank Altay Alves Lino de Souza for statistical advice.

Funding

FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo).

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Authors and Affiliations

  1. Instituto do Coração (InCor), Universidade de São Paulo (USP), São Paulo/SP, Brazil

    Sara Q. C. Giampá, Sofia F. Furlan, Luiz A. Bortolotto, Geraldo Lorenzi-Filho & Luciano F. Drager

  2. Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Universidade de Pernambuco (UPE), Recife/PE, Brazil

    Rodrigo P. Pedrosa

  3. Instituto Dante Pazzanese de Cardiologia, São Paulo/SP, Brazil

    Carolina C. Gonzaga, Adriana Bertolami & Celso Amodeo

  4. Hypertension Unit, Renal Division, Universidade de São Paulo (USP), São Paulo/SP, Brazil

    Luciano F. Drager

Authors
  1. Sara Q. C. Giampá
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  2. Rodrigo P. Pedrosa
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  3. Carolina C. Gonzaga
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  4. Adriana Bertolami
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  5. Celso Amodeo
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  6. Sofia F. Furlan
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  7. Luiz A. Bortolotto
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  8. Geraldo Lorenzi-Filho
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  9. Luciano F. Drager
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Correspondence to Luciano F. Drager.

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Giampá, S.Q.C., Pedrosa, R.P., Gonzaga, C.C. et al. Performance of NoSAS score versus Berlin questionnaire for screening obstructive sleep apnoea in patients with resistant hypertension. J Hum Hypertens 32, 518–523 (2018). https://doi.org/10.1038/s41371-018-0072-z

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