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Diagnostic characteristics of clinical prediction models for obstructive sleep apnea in different clinic populations

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Abstract

Purpose

As predictive factors and their diagnostic values are affected by the characteristics of the population studied, clinical prediction model for obstructive sleep apnea (OSA) may exhibit different diagnostic characteristics in different populations. We aimed to compare the diagnostic characteristics of clinical prediction models developed in two different populations.

Methods

One hundred seventeen consecutive clinic patients (group 1) were evaluated to develop a clinical prediction model for OSA (local model). The diagnostic characteristics of this local model were compared with those of a foreign model by applying both models to another group of 52 patients who were referred to the same clinic (group 2). All patients underwent overnight polysomnography.

Results

The local model had an area under receiver operator characteristics curve of 79%. A cutoff of 0.6 was associated with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 77.9%, 72.5%, 84.5%, and 63.0%, respectively. The overall diagnostic accuracy, sensitivity, specificity, PPV, and NPV of the local model using data from patients in group 2 were 69.0%, 78.1%, 45.0%, 69.4%, and 56.3%, respectively. The foreign model had an overall diagnostic accuracy of 64.0% when applied to data from patients in group 2. At the optimal cutoff of 17, the foreign model was associated with sensitivity of 38.2%, specificity of 83.3%, NPV of 41.7% and PPV of 81.3%.

Conclusions

Clinical prediction model for OSA derived from a foreign population exhibits markedly different diagnostic characteristics from one that is developed locally, even though the overall accuracy is similar. Our findings challenge the predictive usefulness and the external validity of clinical prediction models.

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Abbreviations

AHI:

Apnea–hypopnea index

BMI:

Body mass index

CPAP:

Continuous positive airway pressure

NPV:

Negative predictive value

OSA:

Obstructive sleep apnea

PPV:

Positive predictive value

PSG:

Polysomnography

ROC:

Receiver operating characteristic

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Acknowledgement

We thank Ms. Faezah binte Jumairi for her assistance in data entry.

Disclosure

See-Meng Khoo, Hze-Khoong Poh, Yiong-Huak Chan, Wang-Jee Ngerng, Dong-Xia Shi, and TK Lim do not have conflict of interest to declare.

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Authors and Affiliations

  1. Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, 5, Lower Kent Ridge Road, Singapore, 119074, Singapore

    See-Meng Khoo, Wang-Jee Ngerng, Dong-Xia Shi & T. K. Lim

  2. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore

    Hze-Khoong Poh

  3. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Yiong-Huak Chan

Authors
  1. See-Meng Khoo
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  2. Hze-Khoong Poh
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  5. Dong-Xia Shi
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  6. T. K. Lim
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Correspondence to See-Meng Khoo.

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Khoo, SM., Poh, HK., Chan, YH. et al. Diagnostic characteristics of clinical prediction models for obstructive sleep apnea in different clinic populations. Sleep Breath 15, 431–437 (2011). https://doi.org/10.1007/s11325-010-0354-3

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  • DOI: https://doi.org/10.1007/s11325-010-0354-3

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