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STOP-BANG screener versus objective obstructive sleep apnea testing among younger veterans with PTSD and insomnia: STOP-BANG does not sufficiently detect risk.

STUDY OBJECTIVES
Posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) co-occur in veterans even who are younger with lower body mass index (BMI). The STOP-BANG screener for OSA relies heavily on high blood pressure, age, and BMI, and may not generalize to veterans with PTSD. The inability to effectively screen veterans for OSA is problematic given negative outcomes of untreated OSA.


METHODS
Our study compared the STOP-BANG to objective OSA diagnostic testing in 48 younger veterans (mean age=43.7 years; 43.8% Caucasian; 20.8% female) seeking treatment for PTSD and insomnia. Apnea-hypopnea events per hour (AHI), recorded by NOX T3 sleep monitors, were used to diagnose OSA (AHI≥5). Logistic regressions examined how STOP-BANG cut-off scores (≥ 3 and ≥5) classified OSA status (AHI≥5). Follow-up chi-square goodness of fit tests examined single-item STOP-BANG performance in the OSA positive subsample (n=28).


RESULTS
The STOP-BANG (≥3) had good sensitivity (92.6%), but poor specificity (47.6%), negative (0.16) and positive (1.77) likelihood ratios. The STOP-BANG (≥ 5) led to improved specificity (76.19%), but sensitivity (37.04%) and positive (1.56)/negative likelihood ratios (0.83) were poor. Single-item OSA subgroup analyses revealed that BMI, age, and neck circumference performed poorly, while, tiredness and gender performed well.


CONCLUSIONS
Findings suggest that the STOP-BANG correctly diagnosed OSA in some veterans, but missed OSA in large number of younger veterans with PTSD. This suggests objective diagnostic OSA testing is needed in veterans with PTSD. Future research is needed to develop more accurate OSA screening measures in this population.


CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov, Title: Integrated CBT-I on PE and PTSD Outcomes (Impact Study), Identifier: NCT02774642, URL: https://www.clinicaltrials.gov/ct2/show/NCT02774642.