Obstructive Sleep Apnea Syndrome in Company Workers: Development of a Two-Step Screening Strategy with a New Questionnaire ARTICLE in JOURNAL OF CLINICAL SLEEP MEDICINE: JCSM: OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE

Study Objectives: To develop and evaluate a screening questionnaire and a two-step screening strategy for Obstructive Sleep Apnea Syndrome (OSAS) in healthy workers. Design: Cross-sectional study Setting and participants: A total of 1861 employees comprising healthy blue and whitecollar workers in two representative plants in the Netherlands from a worldwide consumer electronic company were approached to participate. Interventions: Employees were invited to complete various sleep questionnaires, and undergo nasal flow recording and home polysomnography on two separate nights. Measurements and Results: Of the 1861 employees 249 gave informed consent and from 176 (70.7%) all nasal flow and polysomnography data were available. OSAS was diagnosed in 65 (36.9%). A combination of age, absence of insomnia, witnessed breathing stops and 3way scoring of the Berlin and STOPBANG questionnaires best predicted OSAS. Factor analysis identified a six-factor structure of the resulting new questionnaire: snoring, snoring severity, tiredness, witnessed apneas, sleep quality and daytime well-being. Subsequently, some questions were removed, and the remaining questions were used to construct a new questionnaire. A scoring algorithm, computing individual probabilities of OSAS as high, intermediate or low risk, was developed. Subsequently, the intermediate risk group was split into low and high probability for OSAS, based on nasal flow recording. This two-step approach showed a sensitivity of 63.1%, and a specificity of 90.1%. The latter is important for low prevalence populations. Conclusion: A two-step screening strategy with a new questionnaire and subsequent nasal flow recording is a promising way to screen for OSAS in a healthy worker population.