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

中文翻译：

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在患有 PTSD 和失眠症的年轻退伍军人中，STOP-BANG 筛选器与客观阻塞性睡眠呼吸暂停测试的对比：STOP-BANG 不能充分检测风险

学习目标：

创伤后应激障碍 (PTSD) 和阻塞性睡眠呼吸暂停 (OSA) 在退伍军人中同时发生，即使是较年轻且体重指数 (BMI) 较低的退伍军人也是如此。OSA 的 STOP-BANG 筛查在很大程度上依赖于高血压、年龄和 BMI，可能无法推广到患有 PTSD 的退伍军人。鉴于未经治疗的 OSA 的负面结果，无法有效筛查 OSA 退伍军人是有问题的。

方法：

我们的研究比较了 48 名寻求 PTSD 和失眠治疗的年轻退伍军人（平均年龄 = 43.7 岁；43.8% 白人；20.8% 女性）的 STOP-BANG 与客观 OSA 诊断测试。NOX T3 睡眠监测仪记录的每小时呼吸暂停低通气事件 (AHI) 用于诊断 OSA (AHI≥5)。逻辑回归检验了 STOP-BANG 截止分数（≥ 3 和 ≥ 5）如何对 OSA 状态 (AHI ≥ 5) 进行分类。后续卡方拟合优度检验检查了 OSA 阳性子样本 ( n =28) 中的单项 STOP-BANG 性能。

结果：

STOP-BANG (≥3) 具有良好的敏感性 (92.6%)，但特异性较差 (47.6%)，阴性 (0.16) 和阳性 (1.77) 似然比。STOP-BANG (≥ 5) 提高了特异性 (76.19%)，但敏感性 (37.04%) 和阳性 (1.56)/阴性似然比 (0.83) 很差。单项 OSA 亚组分析显示 BMI、年龄和颈围表现不佳，而疲劳和性别表现良好。

结论：

研究结果表明，STOP-BANG 在一些退伍军人中正确诊断出 OSA，但在大量患有 PTSD 的年轻退伍军人中错过了 OSA。这表明患有 PTSD 的退伍军人需要进行客观诊断性 OSA 测试。未来的研究需要在这一人群中制定更准确的 OSA 筛查措施。

临床试验注册：

登记处：ClinicalTrials.gov，标题：PE 和 PTSD 结果的综合 CBT-I（影响研究），标识符：NCT02774642，URL：https://www.clinicaltrials.gov/ct2/show/NCT02774642