# Toward developing more effective screening questionnaires for obstructive sleep apnoea: a conceptual model and testing

## TL;DR

This study improves OSA screening by identifying key factors and proposing a more effective two-step questionnaire based on patient data and statistical analysis.

## Contribution

A novel conceptual model and two-step questionnaire structure for more accurate OSA screening.

## Key findings

- Sex, BMI, age, and GERD are crucial factors in OSA development and should be included in updated questionnaires.
- A two-step questionnaire can distinguish OSA patients with 91.87% accuracy, 78.2% sensitivity, and 96.5% specificity.
- Sleep quality and quality of life show complex relationships with OSA, varying significantly between patients and non-patients.

## Abstract

‘Paper-and-pencil’ questionnaires are essential tools for the preliminary screening of obstructive sleep apnoea (OSA), a condition that is rapidly becoming more common yet often remains underdiagnosed. The most commonly used simple tests were developed several decades ago and require updating. This research aims to gain a better understanding of the various factors that contribute to the development of OSA.

A total of 911 patients participated in the study and completed a self-designed questionnaire that assessed their perceptions of the intensity of various risk factors for OSA, associated comorbid conditions, sleep quality, and lifestyle-related characteristics. Following this, polysomnography was conducted to objectively evaluate the severity of OSA. The relationships among predisposing and contributing factors, as well as the perceived symptoms of OSA, were analysed using partial least squares regression.

Our findings emphasise the crucial roles of sex, body mass index, age, and the presence of gastroesophageal reflux disease in the development of OSA. Therefore, questions about these factors should be included in a future, updated questionnaire. The relationships between sleep quality, quality of life, and OSA is highly complex; both their values and the directions of their regression parameters vary significantly between OSA patients and those without OSA. It is possible to distinguish OSA patients with 91.87% accuracy, achieving high sensitivity (78.2%) and specificity (96.5%), based on the structure of path and regression coefficients.

Our findings indicate opportunities for developing more effective and targeted questionnaires that remain relatively simple without being overly simplified. We discovered that a two-step question format could yield the most beneficial outcomes.