***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To evaluate joint task force criteria -based screening for severe obstructive sleep apnea ( s-OSA ) in commercial drivers . Methods : Among a community-based cohort of licensed commercial vehicle drivers , we assessed utility of the joint task force criteria . We conducted full , 14-channel overnight polysomnography in all drivers , defining s-OSA as an apnea – hypopnea index of 30 or more per hour . Results : One hundred of 104 drivers with successful polysomnography studies were predominantly obese ( median body mass index = 32.8 kg/m2 ; interquartile range = 26.8 to 37.4 ) and had a  median apnea — hypopnea index  of 20.6 per hour ( interquartile range = 10.0 to 34.2 ) . Examination-based criteria were more effective ( sensitivity = 80 % ; negative posttest probability [ nPTP ] = 17 % ) than symptom-based criteria ( sensitivity = 63 % ; nPTP = 23 % ) . Examination and symptom-based criteria combined had high sensitivity ( 97 % ) and low nPTP ( 7 % ) , but poor specificity ( 19 % ) . Conclusions : Examination-based criteria missed 20 % of s-OSA cases . Combining examination with confidentially reported symptoms improved sensitivity but required confirmatory polysomnography in 86 % , supporting universal screening of all drivers Introduction Home respiratory polygraphy ( HRP ) may be a cost-effective alternative to polysomnography for the diagnosis of  sleep apnoea-hypopnoea syndrome ( SAHS ) , but stronger evidence is needed . Normally , patients transport HRP equipment from the hospital to home and back , which may create difficulties for some patients . Objectives To determine both the diagnostic efficacy and cost of HRP ( with and without a transportation service moving the device and telematic transmission of data ) in a large sample compared with in-hospital polysomnography . Methods Patients suspected of having SAHS were included in a multicentre study ( eight hospitals ) . They were assigned to home and hospital protocol s in r and om order . Receiver operating characteristic curves were constructed for manual respiratory polygraphy scoring protocol and different polysomnographic cut-off points . Diagnostic efficacies for several polysomnographic cut-off points were explored and costs for two equally effective alternatives were calculated . Results Of 366 r and omised patients , 348 completed the protocol . The best receiver operating characteristic curve was obtained with a polysomnographic cut-off of the apnoea-hypopnoea index (AHI)≥5 . The sensitive HRP AHI cut-off point ( < 5 ) had a sensitivity of 96 % , a specificity of 57 % and a negative likelihood ratio ( LR ) of 0.07 ; the specific cut-off ( > 10 ) had a sensitivity of 87 % , a specificity of 86 % and a positive LR of 6.25 . The cost of HRP  was half that of polysomnography . Telematic transmission costs were similar if the patients ' costs were taken in to account . Conclusion HRP is an alternative to polysomnography in patients with suspected SAHS . Telematic procedures may help patients with limited mobility and those who live a long way from the sleep centre BACKGROUND Obstructive sleep apnea hypopnea syndrome ( OSAHS ) is underdiagnosed . Screening patients at high risk of OSAHS is extremely important . Using the st and ard question naire to screen OSAHS is a practical method . This study aim ed to evaluate the value of the STOP-Bang question naire ( SBQ ) in screening OSAHS in sleep-disordered breathing clinic by comparing it with the Epworth sleepiness scales ( ESS ) , Berlin question naire , and STOP question naire . METHODS In this study , 212 patients at the sleep-disordered breathing clinic of the Peking Union Medical College Hospital between May 2011 and January 2012 were prospect ively included . They were asked to fill in the SBQ , ESS , Berlin question naire , and STOP question naire before overnight polysomnography ( PSG ) . Using PSG as gold st and ard , the sensitivities and specificities of SBQ were compared with those of ESS , Berlin question naire , and STOP question naire . RESULTS There was no significance in applying ESS score ≥11 to screen OSAHS and detect moderate and severe OSAHS ( P > 0.05 ) . SBQ was superior to Berlin question naire and STOP question naire in screening OSAHS and detecting the severity of OSAHS patients . The sensitivities of SBQ score ≥3 with apnea hypopnea index ( AHI ) ≥5/h , AHI ≥15/h , and AHI ≥30/h as gold st and ards were 94.9 % , 96.5 % , and 97.7 % , respectively . The specificities were 50.0 % , 28.6 % , and 17.9 % , respectively . The area upper curves were 0.815 ( 0.706 - 0.925 , P < 0.01 ) , 0.746 ( 0.665 - 0.828 , P < 0.01 ) , and 0.751 ( 0.686 - 0.817 , P < 0.01 ) , respectively . According to SBQ , the population was classified into high-risk group and low-risk group . The gender , BMI , neck circumference , AHI , LSpO2 , and number of subjects of AHI ≥5/h , AHI ≥15/h , and AHI ≥30/h of these two groups were significantly different . CONCLUSIONS The SBQ has superior predictive value compared with ESS , Berlin question naire , and STOP question naire . It should be used further in screening for OSAHS in the general population STUDY OBJECTIVES To test the utility of an integrated clinical pathway for obstructive sleep apnea ( OSA ) diagnosis and continuous positive airway pressure ( CPAP ) treatment using portable monitoring devices . DESIGN R and omized , open-label , parallel group , unblinded , multicenter clinical trial comparing home-based , unattended portable monitoring for diagnosis and autotitrating CPAP ( autoPAP ) compared with in-laboratory polysomnography ( PSG ) and CPAP titration . SETTING Seven American Academy of Sleep Medicine ( AASM ) accredited sleep centers . PARTICIPANTS Consecutive new referrals , age 18 yr or older with high probability of moderate to severe OSA ( apnea-hypopnea index [ AHI ] ≥ 15 ) identified by clinical algorithm and Epworth Sleepiness Scale ( ESS ) score ≥ 12 .  INTERVENTIONS Home-based level 3 testing followed by 1 wk of autoPAP with a fixed pressure CPAP prescription based on the 90 % pressure from autotitration of PAP therapy ( autoPAP ) device ( HOME ) compared with attended , in-laboratory studies ( LAB ) . MEASUREMENTS CPAP acceptance , time to treatment , adherence at 1 and 3 mo ; changes in ESS , and functional outcomes . RESULTS Of 373 participants , approximately one-half in each study arm remained eligible ( AHI ≥ 15 ) to continue in the study . At 3 mo , PAP usage ( nightly time at pressure ) was 1 hr greater : 4.7 ± 2.1 hr ( HOME ) compared with 3.7 ± 2.4 hr ( LAB ) . Adherence ( percentage of night used ≥ 4 hr ) was 12.6 % higher : 62.8 ± 29.2 % compared with 49.4 ± 36.1 % in the HOME versus LAB . Acceptance of PAP therapy , titration pressures , effective titrations , time to treatment , and ESS score change did not differ between arms . CONCLUSIONS A home-based strategy for diagnosis and treatment compared with in-laboratory PSG was not inferior in terms of acceptance , adherence , time to treatment , and functional improvements . TRIAL REGISTRATION http://www . Clinical Trials.gov ; Identifier : NCT : 00642486 A simple screening method for  sleep-disordered breathing ( SDB ) is desirable for primary care practice s. In the present study , a simple monitor , which utilises a new type of flow sensor and a novel algorithm , was prospect ively vali date d. Home recording for 2 nights with the monitor only , followed by in-laboratory recording with the monitor together with polysomnography , were carried out in consecutive patients ( n = 100 ) suspected of SDB . A subjective sleep log was also recorded . The signal was analysed using power spectral analysis , which yielded the flow respiratory disturbance index ( flow-RDI ) . There was no recording failure at home . The reproducibility of the flow-RDI between the 2 nights at home was high ( intraclass correlation coefficient = 0.92 ) . The sensitivity and specificity of the in-laboratory flow-RDI to diagnose SDB were 0.96 and 0.82 , 0.91 and 0.82 , and 0.89 and 0.96 , for apnoea/hypopnoea index ( AHI ) ≥5 , ≥15 and ≥30 events·h−1 , respectively . The diagnostic ability in low-severity subgroups ( female , normal weight , AHI < 15 events·h−1 ) was almost comparable to that in the entire group . Excluding subjective waking time on the sleep log from the recording time had no significant effect on the flow-RDI . The single-channel monitor is considered feasible for ambulatory sleep disordered breathing monitoring because of its easy applicability , high reproducibility and relatively high agreement with polysomnography results OBJECTIVES This study aims to assess the reliability of SleepStrip as a screening test in obstructive sleep apnea syndrome ( OSAS ) . PATIENTS AND METHODS Seventy-two patients ( 50 males , 22 females ; mean age 51.4±11.1 years ; range 20 to 74 years ) with OSAS were included in this prospect i ve , non-r and omized double-blinded single cohort study between May 2008 and February 2009 . Patients who underwent an attended overnight polysomnography ( PSG ) and consented to participate in the study were asked to use SleepStrip device within the week following PSG recording . The apnea-hypopnea index ( AHI ) was compared with the SleepStrip score ( Sscore ) . RESULTS  The mean body mass index of patients was 31.1±4.3 . Both AHI and Sscore were obtained in 64 patients . There was a strong correlation between Sscore and AHI ( r=0.76 , p<0.001 ) . The sensitivity and specificity of the SleepStrip were 94.4 % and 93.5 % when used to diagnose cases with AHI = or > 40 . The sensitivity and specificity of the SleepStrip was reduced to 80 % and 87.2 % when AHI threshold was chosen as = or > 25 and 83.3 % and 76.5 % for AHI = or > 15 respectively . CONCLUSION There is a strong correlation between SleepStrip and AHI . SleepStrip was found to be effective in diagnosing severe OSAS with AHI = or > 40 , however , its diagnostic capability was reduced in patients with lower AHI 's who constitute the main target of screening BACKGROUND The STOP-Bang question naire is a vali date d screening tool for the identification of surgical patients with obstructive sleep apnea ( OSA ) . A STOP-Bang score ≥ 3 is highly sensitive but only moderately specific . Apnea/hypopnea during sleep can lead to intermittent hypercapnia and may result in serum bicarbonate ( HCO₃⁻ ) retention . The addition of serum HCO₃⁻ level to the STOP-Bang question naire may improve its specificity . METHODS Four thous and seventy-seven preoperative patients were approached for consent and screened by the STOP-Bang question naire . Polysomnography was performed and preoperative HCO₃⁻ level was collected in 384 patients . Study participants were r and omly assigned to a derivation or validation cohort . Predictive parameters ( sensitivity , specificity , positive and negative predictive values ) for STOP-Bang score and serum HCO₃⁻ level were calculated . RESULTS In the derivation cohort , with a STOP-Bang score ≥ 3 , the specificity for all OSA , moderate/severe OSA , and severe OSA was 37.0 % , 30.4 % , and 27.7 % , respectively . HCO₃⁻ level of 28 mmol/L was selected as a cutoff for analysis . With the addition of HCO₃⁻ level ≥ 28 mmol/L to the STOP-Bang score ≥ 3 , the specificity for all OSA , moderate/severe OSA , and severe OSA improved to 85.2 % , 81.7 % , and 79.7 % , respectively . Similar improvement was observed in the validation cohort . CONCLUSION Serum HCO₃⁻ level increases the specificity of STOP-Bang screening in predicting moderate/severe OSA . We propose a two-step screening process . The first step uses a STOP-Bang score to screen patients , and the second step uses serum HCO₃⁻ level in those with a STOP-Bang score ≥ 3 for increased specificity The obstructive sleep apnea syndrome ( OSAS ) is a sleep disorder associated with excessive day-time sleepiness ; sleep fragmentation ; intermittent hypoxia ; and increased risk for diurnal hypertension , myocardial infa rct ion , ventricular failure , pulmonary hypertension , cardiac dysrhythmias 
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A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients .
Polysomnography is the st and ard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation .