General Practice Sleep Scale - The "GPSS" - A proposed new tool for use in General Practice for risk assessment of Obstructive Sleep Apnoea

Timothy Howarth; Joe Hedger; Winnie Chen; Himanshu Garg; Subash S Heraganahally

doi:10.1016/j.sleep.2024.11.022

General Practice Sleep Scale - The "GPSS" - A proposed new tool for use in General Practice for risk assessment of Obstructive Sleep Apnoea

Sleep Med. 2024 Nov 21:125:168-176. doi: 10.1016/j.sleep.2024.11.022. Online ahead of print.

Authors

Timothy Howarth¹, Joe Hedger², Winnie Chen³, Himanshu Garg⁴, Subash S Heraganahally⁵

Affiliations

¹ Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia; Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
² Flinders University, College of Medicine and Public Health, Darwin, Northern Territory, Australia.
³ Flinders University, College of Medicine and Public Health, Darwin, Northern Territory, Australia; General Practice, Danila Dilba, Aboriginal Health Service, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia.
⁴ Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
⁵ Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia; Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia; School of Medicine, Charles Darwin University, Darwin, Northern Territory, Australia. Electronic address: Subash.heraganahally@nt.gov.au.

PMID: 39612716
DOI: 10.1016/j.sleep.2024.11.022

Abstract

Background: This pilot study investigated a new simplified OSA screening tool that could be used in primary care/GP settings - the "GPSS" tool - "General Practice Sleep Scale" and compared against common existing OSA screening tools.

Methods: A convenience sample of patients attending the respiratory and sleep clinic in the Northern Territory of Australia were included if they completed the GPSS prior to undergoing a diagnostic polysomnography. The GPSS contained 9 questions to provide information on: sex, age, body mass index, neck circumference, snoring, witnessed apnoeas, morning tiredness, daytime sleepiness and presence of hypertension/diabetes/heart disease/depression. Presence of OSA was defined as an apnoea-hypopnoea index of ≥15/hour. The GPSS scoring was developed via log odds of regression predictions for each GPSS question upon OSA.

Results: 159 patients (65 % male, median age 45 years) were enrolled. A minimum score of 1 was assigned to GPSS questions, up to 5 for the strongest predictor (neck circumference). The median total GPSS score was 13 (IQR 9, 16) (maximum 22) and correlated strongly with OSA (AUC 0.812 (95 % CI 0.744, 0.881)). Categorised into low (0-7), moderate (8-13) or high risk (>13), a moderate or severe score had sensitivity 100, specificity 34.9 %. The GPSS significantly outperformed the Epworth Sleepiness Scale, Berlin questionnaire and OSA-50, and was comparable but slightly improved against the STOP-Bang.

Conclusions: The proposed GPSS tool could be of use in general practice settings. Further prospective research is warranted to test the applicability and adaptability of the GPSS tool in wider population settings.

Keywords: Clinical tools; Diagnosis; Differential; Outcome assessment; Practice management; Risk assessment; Sleep disorders.