The utility of the elbow sign in the diagnosis of OSA

Abstract

Background: Obstructive sleep apnea (OSA) is a common condition in which there are intermittent partial and complete limitations in airflow, with associated hypoxia and sympathetic arousals, during sleep. Many patients presenting to our sleep disorders clinic reported being elbowed or poked by their bed partner because of snoring or witnessed apneic spells. The aim of this work is to explore if a screening questionnaire can be used for detection of OSA patients. Methods: A prospective study conducted on patients referred for polysomnography in the form of questionnaire consisting of two questions: (1) Does your bed partner ever poke or elbow you because you are snoring? If yes how many times per night? (2) Does your bed partner ever poke or elbow you because you have stopped breathing? If yes how many times per night? Age, sex, weight and height were collected. Results: Snoring event(s) and apneic event(s) were present in 47 patients, of them 40 patients had OSA (AHI ⩾5) with sensitivity: 82%, specificity: 76%, PPV: 85%, NPV: 71%. There was an increase in the patients being awakened by snoring event(s) and apneic event(s) as the disease severity increased. Age group definition (<50 years) and BMI definition (⩾35 kg/m2) in patients reporting snoring event(s) add a benefit as a good pretest predictor of OSA. Conclusion: The elbow sign questionnaire is a simple and quick screening tool for OSA with good sensitivity and specificity in comparison to other questionnaires, further studies are needed in other populations to determine its reliability and predictive utility.

Keywords

• Obstructive sleep apnea
• Elbow sign
• Polysomnography
• Snoring events
• Apneic events