Cross-cultural adaptation and validation of the STOP-bang Questionnaire from English to Spanish as a tool for the early detection of sleep apnea syndrome in the surgical patient and in the general population | Revista Española de Anestesiología y Reanimación (English Edition)

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Maimó Bordoy, K. El Haji, J.L. Aguilar Sánchez, S. Tejada Gavela" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M.D." "apellidos" => "Mira Quirós" "email" => array:1 [ 0 => "mdmira888@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Maimó Bordoy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "K." "apellidos" => "El Haji" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J.L." "apellidos" => "Aguilar Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Tejada Gavela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Son Llàtzer, Palma, Balearic Islands, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Son Llàtzer, Palma, Balearic Islands, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Investigación, Hospital Universitario Son Llàtzer, Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Facultad de Medicina, Universidad de las Islas Baleares, Palma, Balearic Islands, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adaptación transcultural y validación del cuestionario STOP-bang del inglés al español como herramienta de detección precoz del síndrome de apnea del sueño en el paciente quirúrgico y en la población general" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1736 "Ancho" => 2529 "Tamanyo" => 323958 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Cross-cultural adaptation and validation of health questionnaires: review and methodological recommendations. AUC: area under the curve; NPV: negative predictive value; PPV: positive predictive value. Source: adapted from Ramada-Rodilla JM et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>." ] ] ] "textoCompleto" => "IntroductionSleep apnoea syndrome (SAS) or sleep apnoea/hypopnoea syndrome (SAHS) is a highly prevalent sleep disorder that affects between 5% and 28% of the general population, and increases with age. It is associated with poor quality of life, high blood pressure, cardiovascular and cerebrovascular diseases, traffic accidents, and excess mortality<a class="elsevierStyleCrossRef" href="#bib0005">1</a>. The syndrome is characterized by periods of upper airway obstruction during sleep that cause intermittent hypoxemia, hypercapnia, and sleep fragmentation. For all these reasons, it is considered a major public health problem<a class="elsevierStyleCrossRef" href="#bib0010">2</a>. Different epidemiological studies in developed or developing countries report a prevalence of 3%–7% in the adult male population and 2%–5% in women. In Spain, between 3% and 6% of the population suffers from symptomatic SAHS<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a>.The term sleep apnoea was first used by C. Guilleminault in the mid-1970s to define people who present obstructive apnoeas and excessive daytime somnolence. Since then, different terms to describe the phenomenon have emerged in the literature: hypersomnia with periodic breathing (HPB), obstructive sleep apnoea syndrome (OSAS), sleep apnoea syndrome (SAS), etc. In 2005, the name sleep apnoea hypopnoea syndrome (SAHS) appeared as a new concept in a position statement by the Spanish Sleep Group (GES) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) in collaboration with 15 scientific societies, the Collegiate Medical Organization (OMC) and the General Directorate of Traffic (DGT)<a class="elsevierStyleCrossRef" href="#bib0020">4</a>.Apnoea is defined as a 90% reduction in airflow from baseline during sleep for at least 10 s and hypopnoea as a reduction of between 50%–90% for 10 s. The diagnosis of SAHS is confirmed by calculating the apnoea-hypopnoea index (AHI), i.e., the number of apnoeas and hypopnoeas per hour of sleep, using conventional nocturnal polysomnography (PSG). The severity of SAHS is defined by a series of AHI cut off scores: 5–14 (mild), 15–29 (moderate), and >30 (severe). The gold standard for the diagnosis of OSAS is still conventional PSG monitored by a sleep technician; however, this is a time-consuming, costly, and technically complex test that is beyond the resources available in most health centres. To overcome this hurdle, portable monitors were developed to record respiratory variables using a technique called home respiratory polygraphy (HRP). This technique is now accepted by SEPAR and the American Academy of Sleep Medicine (AASM) to confirm a diagnosis in patients with a moderate suspicion of OSAS<a class="elsevierStyleCrossRef" href="#bib0025">5</a>. HRP reduces costs and waiting time, and makes the diagnosis of SAHS possible in hospitals that do not have conventional PSG.Both anaesthesia and surgery affect the architecture of sleep. Most drugs used during general anaesthesia alter breathing control, attenuate the ventilatory response to hypoxia, hypercapnia and airway obstruction, and can exacerbate the clinical deterioration of patients with SAHS<a class="elsevierStyleCrossRef" href="#bib0030">6</a>. These patients are at higher risk of postoperative adverse events such as hypoxaemia, ischaemic heart disease, haemodynamic instability, arrhythmias, respiratory failure, infection, and postoperative delirium<a class="elsevierStyleCrossRef" href="#bib0035">7</a>, and the incidence of difficult intubation is higher in patients with severe SAHS. The estimated prevalence of SAHS in the surgical population varies, and in some subpopulations it ranges from 30% (neurosurgical patients) to 80% (bariatric patients)<a class="elsevierStyleCrossRef" href="#bib0040">8</a>. However, up to 30% of patients with SAHS are not obese, and studies have also estimated that a large number of surgical patients remain undiagnosed and are not under treatment at the time of surgery<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a>.Given the potential risk of perioperative complications, the guidelines published by the AASM, the American Society of Anesthesiologists (ASA) and the European Society of Anesthesia (ESA)<a class="elsevierStyleCrossRef" href="#bib0055">11</a> recommend using a validated questionnaire to screen patients preoperatively for OSAS in order to reduce perioperative complications<a class="elsevierStyleCrossRef" href="#bib0060">12</a>. In Spain, the most widely used, validated questionnaire for SAHS screening is the Epworth Sleepiness Scale (ESS)<a class="elsevierStyleCrossRef" href="#bib0065">13</a>. This questionnaire is of little use in patients with a low score, because does not assess certain symptoms suggestive of SAHS, such as tiredness, snoring and/or nocturnal apnoea. However, the ASA has validated a number of questionnaires to diagnose SAHS in surgical patients, the most widely used being the Berlin questionnaire (BQ)<a class="elsevierStyleCrossRef" href="#bib0070">14</a> and the STOP-Bang (Snoring, Tiredness during daytime, Observed apnoea, high blood Pressure, BMI, Age, Neck circumference, Gender) questionnaire (SBQ)<a class="elsevierStyleCrossRef" href="#bib0075">15</a> (Appendix B Anex 1). The SBQ contains 8 items that are answered dichotomously (Yes/No); more than 3 positive responses indicates a high risk of SAHS, and less that 3 a low risk.The aim of this study is to evaluate the translated, validated Spanish version of the SBQ to determine whether it is as valid and reliable as the original English version, and can therefore can be a useful and practical tool for the early detection of SAHS previously undiagnosed surgical patients and in the general population.Material and methodValidating a questionnaire in a language other than the original consists of culturally adapting it to the target setting using a complex translation-back-translation methodology, and verifying that it retains the original psychometric properties and is able to measure what it has been designed to measure. This determines the quality of the questionnaire<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a>. Reliability (reproducibility or repeatability) is the extent to which a questionnaire is consistent in measuring a variable, i.e., it obtains the same results in different scenarios and, therefore, these results are comparable. Validity means that the questionnaire measures what is intended to measure. An instrument can be reliable because it is consistent in measuring a variable, but may not be valid if it does not measure the phenomenon to be measured<a class="elsevierStyleCrossRef" href="#bib0090">18</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Cross-cultural adaptation of the STOP-BANG questionnaire to SpanishThe cross-cultural adaptation of questionnaires is a complex methodological process that consists of the translation and cultural adaptation of the original version into another language. There is no standard guideline, and most authors include one or more of the following techniques: translation of the instrument, back translation, bilingual technique, evaluation committee, and pilot feasibility study<a class="elsevierStyleCrossRefs" href="#bib0085">17,19,20</a>. In this study, we followed the guidelines described by Guillemin et al., among other authors<a class="elsevierStyleCrossRefs" href="#bib0080">16,18</a>. First, the SBQ was translated from English to Spanish by 2 independent professional translators, one a native English speaker and the other a Spanish speaker. Next, the research team reviewed the translations and agreed on a preliminary draft of the Spanish version (SBQ V0.1). In the third step, the SBQ V0.1 was back-translated into English by 2 native English-speaking translators, neither of whom had previously seen the original version. The research team reviewed both translations to check whether they were conceptually equivalent. In the next step—harmonization—the team ruled out semantic discrepancies by comparing the 2 back-translated versions with the original questionnaire. In the sixth step, the author(s) of the questionnaire reviewed SBQ V0.1 and the English back-translation of the questionnaire. Following this, a pilot feasibility study was performed in which the SBQ V0.1 was tested on 15 patients from the target population. Each question and the time taken to answer it was monitored, and patients were also asked whether they had understood the question. The results were analysed, and suggestions to improve the questionnaire were considered. Finally, the research team drew up the definitive Spanish version of the STOP-BANG questionnaire (SBQ Vi) (Appendix B Anex 2).Study design and populationRegistered prospective study to validate the cross-cultural translation of the Spanish version of the STOP-bang questionnaire. The study started in January 2017 and lasted 18 months. A total of 77 patients scheduled for non-cardiac surgery and referred from primary care to the HUSLL pulmonology clinic were included. The inclusion criteria were: age over 18 years, and suspected SAHS (evaluated in the pre-anaesthesia consultation or by the hospital’s pulmonologist). Exclusion criteria were: patients with a previous diagnosis of SAHS, patients who completed the questionnaire but did not undergo RP, and patients who had difficulty understanding and reading the questionnaire. Each patient was given detailed information about the study together with a brochure, and agreed to participate by signing the consent form. The patient's anthropometric data were recorded, including weight (kg), height (m) and neck circumference (cm), body mass index (BMI = height/weight2 kg/m2). The patients were weighed and measured in light clothing and barefoot, and the neck circumferences was measured at the level of the cricoid cartilage using an anthropometric tape measure.For the purpose of the pilot study described in the translation phase, the SBQ V1 was tested on the first 15 patients in the target population. Once they had completed the questionnaire, patients were asked how they had interpreted each question and were encouraged to honestly say whether they thought the question was easy to understand. Patients with a score of less than 3 points on the SBQ V1 were classified as low risk for SAHS, and those with a score of 3 points or more were classified as high risk for SAHS.The patients were then referred to the sleep unit to receive a HRP monitor. The risk of SAHS determined by SBQ V1 was compared with the AHI obtained from the HRP monitor. Patients with an AHI of between 5–14 were classed as mild SAHS, those with 15–29 as moderate, and those with >30 as severe. Patients with AHI < 5 did not meet the criteria for SAHS (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Statistical analysisThe data were analysed using descriptive statistics. Quantitative variables are expressed as mean ± standard deviation (age) and those that did not follow a normal distribution as median and range (BMI, overall STOP-BANG score, and AHI). Categorical variables are described as numbers and percentages (ASA, type of surgery, questionnaire variables) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The VI was tested for reliability and validity—core psychometric elements that show the precision and feasibility of a health measurement tool<a class="elsevierStyleCrossRef" href="#bib0085">17</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).The data were analysed using SSPS (Statistical Package for Social Sciences®, v.24), setting the level of significance at P < .05.The reliability of the questionnaire was tested by analysing the internal consistency, reproducibility or stability, and inter-rater agreement. Internal consistency measures the homogeneity of the questionnaire statements, and shows whether they are correlated. The most widely used test is Cronbach's alpha, which ranges from 0 to 1, with less than 0.5 indicating an unacceptable level of reliability. Reproducibility or stability (test-retest) measures the consistency of the responses obtained when the questionnaire is administered on 2 separate occasions, and is evaluated using the Pearson correlation coefficient. Inter-rater agreement measures the degree of concordance between observers who measure the same phenomenon. One of the tests used to estimate it is the Spearman correlation coefficient.Overall validity can be estimated in various ways: face validity, content validity, criterion validity, and construct validity<a class="elsevierStyleCrossRef" href="#bib0090">18</a> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Our questionnaire was tested for criterion and construct validity. We assumed that the original English questionnaire had acceptable face and content validity, so these elements were not evaluated. Both criterion and construct validity are empirical evaluations performed by the authors of the questionnaire and the patients themselves. Concurrent or concomitant validity, i.e., the extent to which the questionnaire scores correlate to a gold standard criterion (AHI), was used to calculate criterion validity. Concurrent validity is expressed by correlation coefficients. We used the Kappa correlation coefficient for qualitative variables or nominal variables, comparing the risk of SAHS determined by STOP-bang (V1) and the AHI obtained from the HRP. Another widely used technique for testing the concurrent validity of other translations of the STOP-BANG is the determination of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROC curve analysis of the SBQ V1; the higher the sensitivity and specificity, the higher the concurrent validity.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Construct validity was tested by calculating the discriminant validity, a type of construct validity that measures the ability of the questionnaire to distinguish between populations that are expected to be different. For this purpose, the patient variable was divided into 2 categories: pre-anaesthesia consultation/pulmonologist consultation, and compared with the SAHS variable of the SBQ V1, categorised as low risk (<3) and high risk (≥3). Bearing in mind that these are both nominal variables, a 2 × 2 contingency table was created and the data were tested using the appropriate Chi-square test for this type of variable.Finally, the validation study was completed by testing feasibility, which measures whether the questionnaire can reasonably be used in the target patient population. Feasibility was calculated on the basis of the percentage of questions answered and the average time the patients included in the pilot study took to answer them.This study was approved by the Research Commission of the Son Llàtzer University Hospital (HUSLL) and by the Research Ethics Committee of the Balearic Islands (CEI-IB). The standards of Good Clinical Practices were followed at all times, and the researchers were given permission by the University Health Network (UHN Technology Development and Commercialization Toronto, ON M5G 1L7, Canada) to use the STOP-bang for academic purposes.ResultsA total of 77 patients were recruited: 24 undergoing SAHS studies under a pulmonologist, and the remained undergoing a preoperative assessment of perioperative risk. Of the 53 patients recruited from the preanaesthesia consultation, only 26 met the inclusion criteria. All patients seen by the pulmonologist were included.The main study variables are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.The sample included 44% women and 56% men, with a mean age of 53.58 ± 12.88 years. Less than half (38%) had a BMI greater than 35 kg/m2, and 50% had a neck circumference greater than 40 cm. In the preanaesthesia consultation, 12% of patients were classed as ASA 3, mostly in the gynaecological/urological surgery (20%) and general surgery (18%) groups.None of the patients taking part in the pilot study had difficulty understanding the questionnaire items. No questionnaire items were left unanswered, and the average time required to complete the SBQ VI questionnaire was 1 min 20 s. This confirms the (100%) feasibility of the instrument.The Cronbach's alpha coefficient was 0.767—a value that indicates good internal consistency. For the test-retest analysis, patients completed the SBQ V1 during their 1st visit and again during their 2nd visit 2 weeks later. The scores were compared using Pearson's correlation (r = 0.772; P = .001), and the questionnaire was found to be reliable. Inter-rater agreement, calculated using Spearman's rho, was 0.455 (P = .044), which indicates an acceptable agreement between raters (in this case, anaesthesiologists vs. pulmonologist).Most of the patients had an STOP-BANG score of 4 (26%) or 6 (28%). Classification of patients as low and high SAHS risk by the SBQ V1 was similar in both groups (pulmonologist/anaesthesiologists), with no significant differences (Pearson's chi-square of 0.015).In 8% of patients, the AHI value (<5) did not meet the criteria for SAHS; 22% of patients had an AHI of between 5 and 14 (mild SAHS), 42% an AHI of between 15 and 29 (moderate SAHS), and 28% an AHI of more than 30 (severe SAHS) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).In the criterion validity test, the Kappa correlation index obtained was 0.444, a moderate strength of agreement between the AHI obtained from the HPR and the questionnaire scores, according to Landis et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> The sensitivity, specificity, area under the curve (AUC), PPV, and NPV for all patients diagnosed with SAHS are described in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The different cut off levels for a score of >3 in the SBQ V1 were: AHI > 5, 15 and 30, sensitivity of 87%, 91% and 100%, respectively. The specificity for each cut off level was 50%, 31% and 22%, respectively.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionFew healthcare professionals are fully aware of the methodology used to adapt validated questionnaires to other languages, which is why these instruments are either translated literally or only partially adapted to the new target population. The World Health Organization (WHO) recommends developing and using standardized health indicators and validated health instruments to allow researchers around the world to compare their results. A simple translation of a health questionnaire designed in another language can cause clinicians to misinterpret the results due to cultural and linguistic difference between the source and target languages. Therefore, in order to obtain an instrument that is equivalent to the original and rule out the risk of obtaining unreliable or non-comparable results, the questionnaire must be translated, culturally adapted and validated according to the recommended methodology<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a>.Our study has been based on the methodology recommended by Beaton et al., among other authors<a class="elsevierStyleCrossRefs" href="#bib0080">16,20</a>, for the cross-cultural adaptation and validation of health measurement instruments. This involves a preliminary cultural adaptation stage in which the questionnaire is translated directly, reviewed, and then back-translated, followed by a second stage in which the final version is validated<a class="elsevierStyleCrossRef" href="#bib0090">18</a>. Although there are no standard guidelines on the cross-cultural adaptation process, the best quality is achieved using translation-back-translation by bilingual or monolingual experts, as described in the material and methods section. The authors of the original questionnaire did not make any changes to the Spanish to English back-translation sent for review<a class="elsevierStyleCrossRef" href="#bib0085">17</a>.Validation testing of the SBQ VI questionnaire showed it to be reliable, valid, reproducible, with an acceptable strength of agreement in the target population, and 100% feasible. The predictive parameters of AHI cut off levels of >15 and >30 were consistent with those in the validation study of the original questionnaire and the validation study from English to Danish. However, for the AHI cut off level of >5, these parameters are not statistically significant (P = .59), possibly because there were not enough patients without SAHS (AHI < 5) to allow comparison with patients with AHI > 5: only 2 patients classified as high-risk by the SAHS questionnaire had AHI < 5.The STOP-bang was the first OSAS screening questionnaire designed and validated for the surgical population<a class="elsevierStyleCrossRef" href="#bib0075">15</a>. Most screening tests had hitherto been developed for the general population, but the extensive list of questions made scoring complicated. The Berlin questionnaire<a class="elsevierStyleCrossRef" href="#bib0070">14</a> is one of the few instruments widely used in the general population; however, it is not suitable for surgical patients because its predictive parameters vary greatly in subpopulations, and it was designed and validated without using PSG as the gold standard diagnosis of OSAS. For all these reasons, another, simpler validated test was needed for the surgical population. This led to the development of the 4-item, dichotomous (yes/no) STOP questionnaire (Snoring, Tiredness during daytime, Observed apnoea, high Blood Pressure) whose predictive variables showed moderate-to-high sensitivity and PPV for the different AHI cut-off levels: >5, >15 and >30. The STOP-bang (Snoring, Tiredness during daytime, Observed apnoea, high blood Pressure, Body mass index, Age, Neck circumference, Gender) was developed by adding 4 more questions (Yes/No) on age (over 50 years), male sex, BMI (>35 kg/m2) and neck circumference (>40 cm), This increased the questionnaire’s sensitivity and NPV, particularly in patients with moderate and severe OSAS. However, one of the main limitations reported in the study was the refusal of many patients to undergo conventional nocturnal PSG (only 177 of the 2721 patients included underwent PSG), mainly because of preoperative anxiety, or reluctance to spend a night in the hospital. This is why other studies in STOP-BANG by the same and other authors included HPR as a diagnostic method<a class="elsevierStyleCrossRef" href="#bib0130">26</a>.Since 2008, when it was first published, the STOP-BANG has been validated in other subpopulations<a class="elsevierStyleCrossRef" href="#bib0135">27</a>: bus drivers, obese individuals, pregnant women, etc., and its role as a screening tool to stratify perioperative risk has been the subject of numerous studies and articles, mainly systematic reviews and meta-analyses, some of low methodological quality. All these studies, however, consistently reported that patients who obtain higher scores on the STOP-BANG have a greater probability of moderate and severe OSAS<a class="elsevierStyleCrossRefs" href="#bib0140">28,29</a>.The UHN-owned STOP-bang website (stopbang.ca) contains simple translations of the questionnaire into many different languages, together with adaptation and validation studies of the STOP-bang from English to various languages, such as Danish, Portuguese and Chinese<a class="elsevierStyleCrossRefs" href="#bib0110">22–24</a>. Although these differ methodologically, they all include a preliminary translation-back-translation phase. In a recent Spanish study to validate the STOP-bang for ENT specialists<a class="elsevierStyleCrossRef" href="#bib0125">25</a>, the authors used the literal Spanish translation of the original, updated in 2015, posted on the «stopnang.ca» website. This update changes the first question of the original STOP-BANG<a class="elsevierStyleCrossRef" href="#bib0130">26</a>, thus increasing its sensitivity.This study has several limitations. It was originally designed for surgical patients, but since many declined to undergo RP, patients referred from primary care to a pulmonology clinic due to suspected SAHS were also recruited. This selection bias was not evident when calculating the discriminant validity, since the classification of patients as low and high risk SAHS according to the SBQ V1 was similar in both groups (pulmonologist vs. anaesthesiologist). However, none of the patients seen by the pulmonologist refused to undergo RP because they already had a suspected diagnosis.HRP was used to calculate AHI, given the technical and organizational difficulties involved in performing nocturnal PSG in the HUSLL; nevertheless, some patients with unclear AHI results underwent confirmational PSG.We have continued to collect data in order to increase the size of our series and improve the statistical significance of the predictive parameters. This, however, does not affect our initial objective or the results of our study.ConclusionThe VI version of the STOP-bang questionnaire translated, adapted and validated in Spanish evaluated in this study is a reliable, valid tool that is easy to understand and implement. As recommended by various scientific societies focused on anaesthesiology and sleep research, this questionnaire can be used to reliably stratify surgical risk and optimise perioperative planning in patients at risk of SAHS that have not been diagnosed before surgery.Using a simple, literary translation of a questionnaire previously validated in another language can lead to unreliable results that cannot be compared with other studies. Instead, according to the recommended methodology, these questionnaires need to undergo a process of cross-cultural adaptation and validation of their most important psychometric features, such as reliability and validity.Conflict of interestsThe authors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1769529" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1554935" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1769528" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introduccion" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y metodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1554936" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and method" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Cross-cultural adaptation of the STOP-BANG questionnaire to Spanish" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study design and population" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-09-07" "fechaAceptado" => "2021-06-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1554935" "palabras" => array:5 [ 0 => "Obstructive sleep apnea" 1 => "Apnea hypopnea syndrome" 2 => "Validation" 3 => "Cross-cultural adaptation" 4 => "STOP-Bang questionnaire" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1554936" "palabras" => array:5 [ 0 => "Apnea obstructiva del sueño" 1 => "Síndrome de apnea hipopnea" 2 => "Validación" 3 => "Adaptación transcultural" 4 => "Cuestionario STOP-Bang" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionObstructive Sleep Apnea Syndrome (OSAS) or Apnea-Hypoapnea Syndrome (SAHS) is one of the most prevalent sleep disorders in the general population. It is associated with an increase in the prevalence of difficult orotracheal intubation and postoperative complications. The application of validated early detection tests, such the STOPbang test in English (STBC), is recommended; a test of high methodological quality, sensitivity and specificity in the early detection of SAHS in both surgical and general populations. ObjectiveThe validation, translation, cross-cultural adaptation of the STBC to the Spanish population. Material and methodsThe transcultural adaptation of the STBC to Spanish was carried out and a subsequent validation study with 77 consecutive patients was carried out. The statistical analysis evaluated the reliability, validity and feasibility of the translated and culturally adapted version. Results44% of women and 56% of men were included, with a mean age of 53.58 ± 12.88 years. The reliability results were: a Cronbach's Alpha Coefficient of 0.767, a Pearson correlation r = 0.777 (P < .001) and a Sperman correlation rho = 0.455 (P = .044). The feasibility of the study was 100%. Criterion validity was evaluated using the Kappa coefficient, which was 0.444. For a score >3 of the questionnaire adapted to Spanish, the results of sensitivity, specificity according to the different cut-off levels of the apnea hypopnea index (AHI) >5, >15, >30) were: Sensitivity 87%, 91% and 100% respectively and Specificity of 50%, 31% and 22%. ConclusionsThe STBC questionnaire translated, adapted and validated into Spanish, evaluated in the present study, is reliable and valid with respect to the original design of the questionnaire. It is a useful tool that is easy to understand and implement, which can be used rigorously to stratify surgical risk and carry out adequate perioperative planning of those patients at risk of SAHS." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroduccionEl Síndrome de Apnea Obstructiva del Sueño (SAOS) o Síndrome de Apnea-Hipoapnea (SAHS) es uno de los trastornos del sueño más prevalentes en la población general. Está asociado a un aumento en la prevalencia de Intubación orotraqueal difícil y de las complicaciones postoperatorias. Se recomienda la aplicación de tests de detección precoz validados como el test en inglés de STOPbang (STBC); un test de alta calidad metodológica, sensibilidad y especificidad en la detección precoz del SAHS tanto en la población quirúrgica como general. ObjetivoLa validación, traducción y adaptación cultural del test STBC a la población española. Material y metodosSe realizó la adaptación transcultural del STBC al español y un estudio de validación posterior con 77 pacientes consecutivos. El análisis estadístico evaluó la fiabilidad, validez y factibilidad de la versión traducida y adaptada culturalmente. ResultadosSe incluyeron 44% de mujeres y 56% de hombres con una edad media de 53,58 ± 12,88 años. Los resultados en la fiabilidad fueron: un Coeficiente Alpha de Cronbach de 0,767, una correlación de Pearson r = 0,777 (P <,001) y una correlación de Sperman rho = 0,455 (P =,044). La factibilidad del estudio fue del 100%. La validez de criterio se evaluó mediante el coeficiente Kappa que fué de 0,444. Para una puntuación > 3 del cuestionario adaptado al español los resultados de sensibilidad, especificidad según los distintos niveles de corte del índice apnea hipoapnea (IAH) >5, >15, >30) fueron: Sensibilidad del 87%, 91% y 100% respectivamente y de Especificidad del 50%, 31% y 22%. ConclusionesEl cuestionario STBC traducido, adaptado y validado al español evaluado en el presente estudio, es fiable y válido con respecto al diseño original del cuestionario. Es una herramienta útil de fácil comprensión e implementación, que puede utilizarse con rigor para estratificar el riesgo quirúrgico y realizar una adecuada planificación perioperatoria de aquellos pacientes con riesgo de SAHS." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introduccion" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y metodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Mira Quirós MD, Maimó Bordoy A, El Haji K, Aguilar Sánchez JL, Tejada Gavela S. Adaptación transcultural y validación del cuestionario STOP-bang del inglés al español como herramienta de detección precoz del síndrome de apnea del sueño en el paciente quirúrgico y en la población general. Rev Esp Anestesiol Reanim. 2022;69:393–401." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0055" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1736 "Ancho" => 2529 "Tamanyo" => 323958 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Cross-cultural adaptation and validation of health questionnaires: review and methodological recommendations. AUC: area under the curve; NPV: negative predictive value; PPV: positive predictive value. Source: adapted from Ramada-Rodilla JM et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2140 "Ancho" => 2508 "Tamanyo" => 235401 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flow chart. Patient selection." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2109 "Ancho" => 2926 "Tamanyo" => 275312 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Single-channel respiratory polygraphy results according to AHI." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AHI: apnoea/hypopnea index; ASA: American Society of Anesthesia classification of anaesthesia risk according to patient status; BMI: body mass index." "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">50 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.58 ± 12.88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ASA (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ASA 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ASA 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ASA 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of surgery (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Genitourinary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">General surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Orthopaedic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ENT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ophthalmology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Snoring (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tiredness during daytime \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observed apnoea: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High blood pressure (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.8 (32.1−36.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2) > 35 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age > 50 years (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neck circumference > 40 cm (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male gender (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">STOP-bang score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (4.42−5.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low risk on STOP-BANG < 3 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate-to-high risk on STOP-BANG ≥ 3 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AHI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.7 (21.28−33.46) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Descriptive analysis of study variables." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Source: Bille J et al.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>.AHI: apnoea/hypopnoea index; AUC: area under the curve; NPV: negative predictive value; PPV: positive predictive value; p Mann-Whitney U, 5% significance level.Data shown as percentages (95% confidence interval)." "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IAH > 5 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IAH > 15 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IAH > 30 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sensitivity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Specificity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AUC (95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.778 (0,573−1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.74 (0.60−0.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.76 (0.63−.90) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P-value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PPV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NPV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AHI: Apnoea/hypopnoea index; AUC: Area under the curve; NPV: negative predictive value; PPV: Positive predictive value; p Mann-Whitney U, significance level 5%.</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Predictive parameters of the original STOP-Bang questionnaire; n = 177</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IAH > 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IAH > 15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IAH > 30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sensitivity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.6 (75.8−89.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.9 (84.1−97.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 (91.0−100.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Specificity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.4 (42.3−69.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 (33.5−52.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (28.9−45.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AUC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.806 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.782 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.822 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PPV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.0 (73.0−87.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.6 (42.5−60.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.0 (23.0−39.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NPV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.8 (46.1−74.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.2 (78.6−96.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 (93.0−100.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adapted from Chung et al. Anesthesiology 2008,108(5)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Data shown as percentages (95% confidence interval)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AHI: Apnoea/hypopnoea index; AUC: Area under the curve; NPV: negative predictive value; PPV: positive predictive value.</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.1- Predictive parameters of the adapted and validated English-Danish STOP-BANG questionnaire; n = 43</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IAH > 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IAH > 15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IAH > 30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sensitivity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.1 (70.1−96.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 (83.9−100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 (69.2−100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Specificity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.0 (53.3−90.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.1 (36.4−79.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.4 (22.9−57.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AUC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.87 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.0005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Data shown as percentages (95% confidence interval)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.1-4]Adapted from Bille J et al. 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Cross-cultural adaptation and validation of the STOP-bang Questionnaire from English to Spanish as a tool for the early detection of sleep apnea syndrome in the surgical patient and in the general population

Adaptación transcultural y validación del cuestionario STOP-bang del inglés al español como herramienta de detección precoz del síndrome de apnea del sueño en el paciente quirúrgico y en la población general

M.D. Mira Quirósa,

Corresponding author

mdmira888@gmail.com

Corresponding author.

, A. Maimó Bordoyb, K. El Hajic, J.L. Aguilar Sánchezd, S. Tejada Gavelad

a Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Son Llàtzer, Palma, Balearic Islands, Spain

b Servicio de Neumología, Hospital Universitario Son Llàtzer, Palma, Balearic Islands, Spain

c Unidad de Investigación, Hospital Universitario Son Llàtzer, Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain

d Facultad de Medicina, Universidad de las Islas Baleares, Palma, Balearic Islands, Spain

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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cross-cultural adaptation and validation of health questionnaires&#58; review and methodological recommendations&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AUC&#58; area under the curve&#59; NPV&#58; negative predictive value&#59; PPV&#58; positive predictive value&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Source&#58; adapted from Ramada-Rodilla JM et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sleep apnoea syndrome &#40;SAS&#41; or sleep apnoea&#47;hypopnoea syndrome &#40;SAHS&#41; is a highly prevalent sleep disorder that affects between 5&#37; and 28&#37; of the general population&#44; and increases with age&#46; It is associated with poor quality of life&#44; high blood pressure&#44; cardiovascular and cerebrovascular diseases&#44; traffic accidents&#44; and excess mortality<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; The syndrome is characterized by periods of upper airway obstruction during sleep that cause intermittent hypoxemia&#44; hypercapnia&#44; and sleep fragmentation&#46; For all these reasons&#44; it is considered a major public health problem<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Different epidemiological studies in developed or developing countries report a prevalence of 3&#37;&#8211;7&#37; in the adult male population and 2&#37;&#8211;5&#37; in women&#46; In Spain&#44; between 3&#37; and 6&#37; of the population suffers from symptomatic SAHS<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The term sleep apnoea was first used by C&#46; Guilleminault in the mid-1970s to define people who present obstructive apnoeas and excessive daytime somnolence&#46; Since then&#44; different terms to describe the phenomenon have emerged in the literature&#58; hypersomnia with periodic breathing &#40;HPB&#41;&#44; obstructive sleep apnoea syndrome &#40;OSAS&#41;&#44; sleep apnoea syndrome &#40;SAS&#41;&#44; etc&#46; In 2005&#44; the name sleep apnoea hypopnoea syndrome &#40;SAHS&#41; appeared as a new concept in a position statement by the Spanish Sleep Group &#40;GES&#41; and the Spanish Society of Pulmonology and Thoracic Surgery &#40;SEPAR&#41; in collaboration with 15 scientific societies&#44; the Collegiate Medical Organization &#40;OMC&#41; and the General Directorate of Traffic &#40;DGT&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Apnoea is defined as a 90&#37; reduction in airflow from baseline during sleep for at least 10 s and hypopnoea as a reduction of between 50&#37;&#8211;90&#37; for 10 s&#46; The diagnosis of SAHS is confirmed by calculating the apnoea-hypopnoea index &#40;AHI&#41;&#44; i&#46;e&#46;&#44; the number of apnoeas and hypopnoeas per hour of sleep&#44; using conventional nocturnal polysomnography &#40;PSG&#41;&#46; The severity of SAHS is defined by a series of AHI cut off scores&#58; 5&#8211;14 &#40;mild&#41;&#44; 15&#8211;29 &#40;moderate&#41;&#44; and &#62;30 &#40;severe&#41;&#46; The gold standard for the diagnosis of OSAS is still conventional PSG monitored by a sleep technician&#59; however&#44; this is a time-consuming&#44; costly&#44; and technically complex test that is beyond the resources available in most health centres&#46; To overcome this hurdle&#44; portable monitors were developed to record respiratory variables using a technique called home respiratory polygraphy &#40;HRP&#41;&#46; This technique is now accepted by SEPAR and the American Academy of Sleep Medicine &#40;AASM&#41; to confirm a diagnosis in patients with a moderate suspicion of OSAS<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; HRP reduces costs and waiting time&#44; and makes the diagnosis of SAHS possible in hospitals that do not have conventional PSG&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Both anaesthesia and surgery affect the architecture of sleep&#46; Most drugs used during general anaesthesia alter breathing control&#44; attenuate the ventilatory response to hypoxia&#44; hypercapnia and airway obstruction&#44; and can exacerbate the clinical deterioration of patients with SAHS<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; These patients are at higher risk of postoperative adverse events such as hypoxaemia&#44; ischaemic heart disease&#44; haemodynamic instability&#44; arrhythmias&#44; respiratory failure&#44; infection&#44; and postoperative delirium<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44; and the incidence of difficult intubation is higher in patients with severe SAHS&#46; The estimated prevalence of SAHS in the surgical population varies&#44; and in some subpopulations it ranges from 30&#37; &#40;neurosurgical patients&#41; to 80&#37; &#40;bariatric patients&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; However&#44; up to 30&#37; of patients with SAHS are not obese&#44; and studies have also estimated that a large number of surgical patients remain undiagnosed and are not under treatment at the time of surgery<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Given the potential risk of perioperative complications&#44; the guidelines published by the AASM&#44; the American Society of Anesthesiologists &#40;ASA&#41; and the European Society of Anesthesia &#40;ESA&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> recommend using a validated questionnaire to screen patients preoperatively for OSAS in order to reduce perioperative complications<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; In Spain&#44; the most widely used&#44; validated questionnaire for SAHS screening is the Epworth Sleepiness Scale &#40;ESS&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; This questionnaire is of little use in patients with a low score&#44; because does not assess certain symptoms suggestive of SAHS&#44; such as tiredness&#44; snoring and&#47;or nocturnal apnoea&#46; However&#44; the ASA has validated a number of questionnaires to diagnose SAHS in surgical patients&#44; the most widely used being the Berlin questionnaire &#40;BQ&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and the STOP-Bang &#40;Snoring&#44; Tiredness during daytime&#44; Observed apnoea&#44; high blood Pressure&#44; BMI&#44; Age&#44; Neck circumference&#44; Gender&#41; questionnaire &#40;SBQ&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> &#40;Appendix B Anex 1&#41;&#46; The SBQ contains 8 items that are answered dichotomously &#40;Yes&#47;No&#41;&#59; more than 3 positive responses indicates a high risk of SAHS&#44; and less that 3 a low risk&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this study is to evaluate the translated&#44; validated Spanish version of the SBQ to determine whether it is as valid and reliable as the original English version&#44; and can therefore can be a useful and practical tool for the early detection of SAHS previously undiagnosed surgical patients and in the general population&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and method</span><p id="par0035" class="elsevierStylePara elsevierViewall">Validating a questionnaire in a language other than the original consists of culturally adapting it to the target setting using a complex translation-back-translation methodology&#44; and verifying that it retains the original psychometric properties and is able to measure what it has been designed to measure&#46; This determines the quality of the questionnaire<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; Reliability &#40;reproducibility or repeatability&#41; is the extent to which a questionnaire is consistent in measuring a variable&#44; i&#46;e&#46;&#44; it obtains the same results in different scenarios and&#44; therefore&#44; these results are comparable&#46; Validity means that the questionnaire measures what is intended to measure&#46; An instrument can be reliable because it is consistent in measuring a variable&#44; but may not be valid if it does not measure the phenomenon to be measured<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Cross-cultural adaptation of the STOP-BANG questionnaire to Spanish</span><p id="par0040" class="elsevierStylePara elsevierViewall">The cross-cultural adaptation of questionnaires is a complex methodological process that consists of the translation and cultural adaptation of the original version into another language&#46; There is no standard guideline&#44; and most authors include one or more of the following techniques&#58; translation of the instrument&#44; back translation&#44; bilingual technique&#44; evaluation committee&#44; and pilot feasibility study<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;19&#44;20</span></a>&#46; In this study&#44; we followed the guidelines described by Guillemin et al&#46;&#44; among other authors<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;18</span></a>&#46; First&#44; the SBQ was translated from English to Spanish by 2 independent professional translators&#44; one a native English speaker and the other a Spanish speaker&#46; Next&#44; the research team reviewed the translations and agreed on a preliminary draft of the Spanish version &#40;SBQ V0&#46;1&#41;&#46; In the third step&#44; the SBQ V0&#46;1 was back-translated into English by 2 native English-speaking translators&#44; neither of whom had previously seen the original version&#46; The research team reviewed both translations to check whether they were conceptually equivalent&#46; In the next step&#8212;harmonization&#8212;the team ruled out semantic discrepancies by comparing the 2 back-translated versions with the original questionnaire&#46; In the sixth step&#44; the author&#40;s&#41; of the questionnaire reviewed SBQ V0&#46;1 and the English back-translation of the questionnaire&#46; Following this&#44; a pilot feasibility study was performed in which the SBQ V0&#46;1 was tested on 15 patients from the target population&#46; Each question and the time taken to answer it was monitored&#44; and patients were also asked whether they had understood the question&#46; The results were analysed&#44; and suggestions to improve the questionnaire were considered&#46; Finally&#44; the research team drew up the definitive Spanish version of the STOP-BANG questionnaire &#40;SBQ Vi&#41; &#40;Appendix B Anex 2&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study design and population</span><p id="par0045" class="elsevierStylePara elsevierViewall">Registered prospective study to validate the cross-cultural translation of the Spanish version of the STOP-bang questionnaire&#46; The study started in January 2017 and lasted 18 months&#46; A total of 77 patients scheduled for non-cardiac surgery and referred from primary care to the HUSLL pulmonology clinic were included&#46; The inclusion criteria were&#58; age over 18 years&#44; and suspected SAHS &#40;evaluated in the pre-anaesthesia consultation or by the hospital&#8217;s pulmonologist&#41;&#46; Exclusion criteria were&#58; patients with a previous diagnosis of SAHS&#44; patients who completed the questionnaire but did not undergo RP&#44; and patients who had difficulty understanding and reading the questionnaire&#46; Each patient was given detailed information about the study together with a brochure&#44; and agreed to participate by signing the consent form&#46; The patient&#39;s anthropometric data were recorded&#44; including weight &#40;kg&#41;&#44; height &#40;m&#41; and neck circumference &#40;cm&#41;&#44; body mass index &#40;BMI &#61; height&#47;weight<span class="elsevierStyleSup">2</span> kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; The patients were weighed and measured in light clothing and barefoot&#44; and the neck circumferences was measured at the level of the cricoid cartilage using an anthropometric tape measure&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">For the purpose of the pilot study described in the translation phase&#44; the SBQ V1 was tested on the first 15 patients in the target population&#46; Once they had completed the questionnaire&#44; patients were asked how they had interpreted each question and were encouraged to honestly say whether they thought the question was easy to understand&#46; Patients with a score of less than 3 points on the SBQ V1 were classified as low risk for SAHS&#44; and those with a score of 3 points or more were classified as high risk for SAHS&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The patients were then referred to the sleep unit to receive a HRP monitor&#46; The risk of SAHS determined by SBQ V1 was compared with the AHI obtained from the HRP monitor&#46; Patients with an AHI of between 5&#8211;14 were classed as mild SAHS&#44; those with 15&#8211;29 as moderate&#44; and those with &#62;30 as severe&#46; Patients with AHI &#60; 5 did not meet the criteria for SAHS &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">The data were analysed using descriptive statistics&#46; Quantitative variables are expressed as mean &#177; standard deviation &#40;age&#41; and those that did not follow a normal distribution as median and range &#40;BMI&#44; overall STOP-BANG score&#44; and AHI&#41;&#46; Categorical variables are described as numbers and percentages &#40;ASA&#44; type of surgery&#44; questionnaire variables&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The VI was tested for reliability and validity&#8212;core psychometric elements that show the precision and feasibility of a health measurement tool<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The data were analysed using SSPS &#40;Statistical Package for Social Sciences&#174;&#44; v&#46;24&#41;&#44; setting the level of significance at <span class="elsevierStyleItalic">P</span> &#60; &#46;05&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The reliability of the questionnaire was tested by analysing the internal consistency&#44; reproducibility or stability&#44; and inter-rater agreement&#46; Internal consistency measures the homogeneity of the questionnaire statements&#44; and shows whether they are correlated&#46; The most widely used test is Cronbach&#39;s alpha&#44; which ranges from 0 to 1&#44; with less than 0&#46;5 indicating an unacceptable level of reliability&#46; Reproducibility or stability &#40;test-retest&#41; measures the consistency of the responses obtained when the questionnaire is administered on 2 separate occasions&#44; and is evaluated using the Pearson correlation coefficient&#46; Inter-rater agreement measures the degree of concordance between observers who measure the same phenomenon&#46; One of the tests used to estimate it is the Spearman correlation coefficient&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Overall validity can be estimated in various ways&#58; face validity&#44; content validity&#44; criterion validity&#44; and construct validity<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Our questionnaire was tested for criterion and construct validity&#46; We assumed that the original English questionnaire had acceptable face and content validity&#44; so these elements were not evaluated&#46; Both criterion and construct validity are empirical evaluations performed by the authors of the questionnaire and the patients themselves&#46; Concurrent or concomitant validity&#44; i&#46;e&#46;&#44; the extent to which the questionnaire scores correlate to a gold standard criterion &#40;AHI&#41;&#44; was used to calculate criterion validity&#46; Concurrent validity is expressed by correlation coefficients&#46; We used the Kappa correlation coefficient for qualitative variables or nominal variables&#44; comparing the risk of SAHS determined by STOP-bang &#40;V1&#41; and the AHI obtained from the HRP&#46; Another widely used technique for testing the concurrent validity of other translations of the STOP-BANG is the determination of sensitivity&#44; specificity&#44; positive predictive value &#40;PPV&#41;&#44; negative predictive value &#40;NPV&#41;&#44; and ROC curve analysis of the SBQ V1&#59; the higher the sensitivity and specificity&#44; the higher the concurrent validity&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Construct validity was tested by calculating the discriminant validity&#44; a type of construct validity that measures the ability of the questionnaire to distinguish between populations that are expected to be different&#46; For this purpose&#44; the patient variable was divided into 2 categories&#58; pre-anaesthesia consultation&#47;pulmonologist consultation&#44; and compared with the SAHS variable of the SBQ V1&#44; categorised as low risk &#40;&#60;3&#41; and high risk &#40;&#8805;3&#41;&#46; Bearing in mind that these are both nominal variables&#44; a 2 &#215; 2 contingency table was created and the data were tested using the appropriate Chi-square test for this type of variable&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Finally&#44; the validation study was completed by testing feasibility&#44; which measures whether the questionnaire can reasonably be used in the target patient population&#46; Feasibility was calculated on the basis of the percentage of questions answered and the average time the patients included in the pilot study took to answer them&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">This study was approved by the Research Commission of the Son Ll&#224;tzer University Hospital &#40;HUSLL&#41; and by the Research Ethics Committee of the Balearic Islands &#40;CEI-IB&#41;&#46; The standards of Good Clinical Practices were followed at all times&#44; and the researchers were given permission by the University Health Network &#40;UHN Technology Development and Commercialization Toronto&#44; ON M5G 1L7&#44; Canada&#41; to use the STOP-bang for academic purposes&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">A total of 77 patients were recruited&#58; 24 undergoing SAHS studies under a pulmonologist&#44; and the remained undergoing a preoperative assessment of perioperative risk&#46; Of the 53 patients recruited from the preanaesthesia consultation&#44; only 26 met the inclusion criteria&#46; All patients seen by the pulmonologist were included&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The main study variables are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The sample included 44&#37; women and 56&#37; men&#44; with a mean age of 53&#46;58 &#177; 12&#46;88 years&#46; Less than half &#40;38&#37;&#41; had a BMI greater than 35 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; and 50&#37; had a neck circumference greater than 40 cm&#46; In the preanaesthesia consultation&#44; 12&#37; of patients were classed as ASA 3&#44; mostly in the gynaecological&#47;urological surgery &#40;20&#37;&#41; and general surgery &#40;18&#37;&#41; groups&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">None of the patients taking part in the pilot study had difficulty understanding the questionnaire items&#46; No questionnaire items were left unanswered&#44; and the average time required to complete the SBQ VI questionnaire was 1 min 20 s&#46; This confirms the &#40;100&#37;&#41; feasibility of the instrument&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The Cronbach&#39;s alpha coefficient was 0&#46;767&#8212;a value that indicates good internal consistency&#46; For the test-retest analysis&#44; patients completed the SBQ V1 during their 1st visit and again during their 2nd visit 2 weeks later&#46; The scores were compared using Pearson&#39;s correlation &#40;r &#61; 0&#46;772&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;001&#41;&#44; and the questionnaire was found to be reliable&#46; Inter-rater agreement&#44; calculated using Spearman&#39;s rho&#44; was 0&#46;455 &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;044&#41;&#44; which indicates an acceptable agreement between raters &#40;in this case&#44; anaesthesiologists vs&#46; pulmonologist&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Most of the patients had an STOP-BANG score of 4 &#40;26&#37;&#41; or 6 &#40;28&#37;&#41;&#46; Classification of patients as low and high SAHS risk by the SBQ V1 was similar in both groups &#40;pulmonologist&#47;anaesthesiologists&#41;&#44; with no significant differences &#40;Pearson&#39;s chi-square of 0&#46;015&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In 8&#37; of patients&#44; the AHI value &#40;&#60;5&#41; did not meet the criteria for SAHS&#59; 22&#37; of patients had an AHI of between 5 and 14 &#40;mild SAHS&#41;&#44; 42&#37; an AHI of between 15 and 29 &#40;moderate SAHS&#41;&#44; and 28&#37; an AHI of more than 30 &#40;severe SAHS&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In the criterion validity test&#44; the Kappa correlation index obtained was 0&#46;444&#44; a moderate strength of agreement between the AHI obtained from the HPR and the questionnaire scores&#44; according to Landis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The sensitivity&#44; specificity&#44; area under the curve &#40;AUC&#41;&#44; PPV&#44; and NPV for all patients diagnosed with SAHS are described in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The different cut off levels for a score of &#62;3 in the SBQ V1 were&#58; AHI &#62; 5&#44; 15 and 30&#44; sensitivity of 87&#37;&#44; 91&#37; and 100&#37;&#44; respectively&#46; The specificity for each cut off level was 50&#37;&#44; 31&#37; and 22&#37;&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Few healthcare professionals are fully aware of the methodology used to adapt validated questionnaires to other languages&#44; which is why these instruments are either translated literally or only partially adapted to the new target population&#46; The World Health Organization &#40;WHO&#41; recommends developing and using standardized health indicators and validated health instruments to allow researchers around the world to compare their results&#46; A simple translation of a health questionnaire designed in another language can cause clinicians to misinterpret the results due to cultural and linguistic difference between the source and target languages&#46; Therefore&#44; in order to obtain an instrument that is equivalent to the original and rule out the risk of obtaining unreliable or non-comparable results&#44; the questionnaire must be translated&#44; culturally adapted and validated according to the recommended methodology<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Our study has been based on the methodology recommended by Beaton et al&#46;&#44; among other authors<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;20</span></a>&#44; for the cross-cultural adaptation and validation of health measurement instruments&#46; This involves a preliminary cultural adaptation stage in which the questionnaire is translated directly&#44; reviewed&#44; and then back-translated&#44; followed by a second stage in which the final version is validated<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Although there are no standard guidelines on the cross-cultural adaptation process&#44; the best quality is achieved using translation-back-translation by bilingual or monolingual experts&#44; as described in the material and methods section&#46; The authors of the original questionnaire did not make any changes to the Spanish to English back-translation sent for review<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Validation testing of the SBQ VI questionnaire showed it to be reliable&#44; valid&#44; reproducible&#44; with an acceptable strength of agreement in the target population&#44; and 100&#37; feasible&#46; The predictive parameters of AHI cut off levels of &#62;15 and &#62;30 were consistent with those in the validation study of the original questionnaire and the validation study from English to Danish&#46; However&#44; for the AHI cut off level of &#62;5&#44; these parameters are not statistically significant &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;59&#41;&#44; possibly because there were not enough patients without SAHS &#40;AHI &#60; 5&#41; to allow comparison with patients with AHI &#62; 5&#58; only 2 patients classified as high-risk by the SAHS questionnaire had AHI &#60; 5&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The STOP-bang was the first OSAS screening questionnaire designed and validated for the surgical population<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Most screening tests had hitherto been developed for the general population&#44; but the extensive list of questions made scoring complicated&#46; The Berlin questionnaire<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> is one of the few instruments widely used in the general population&#59; however&#44; it is not suitable for surgical patients because its predictive parameters vary greatly in subpopulations&#44; and it was designed and validated without using PSG as the gold standard diagnosis of OSAS&#46; For all these reasons&#44; another&#44; simpler validated test was needed for the surgical population&#46; This led to the development of the 4-item&#44; dichotomous &#40;yes&#47;no&#41; STOP questionnaire &#40;Snoring&#44; Tiredness during daytime&#44; Observed apnoea&#44; high Blood Pressure&#41; whose predictive variables showed moderate-to-high sensitivity and PPV for the different AHI cut-off levels&#58; &#62;5&#44; &#62;15 and &#62;30&#46; The STOP-bang &#40;Snoring&#44; Tiredness during daytime&#44; Observed apnoea&#44; high blood Pressure&#44; Body mass index&#44; Age&#44; Neck circumference&#44; Gender&#41; was developed by adding 4 more questions &#40;Yes&#47;No&#41; on age &#40;over 50 years&#41;&#44; male sex&#44; BMI &#40;&#62;35 kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and neck circumference &#40;&#62;40 cm&#41;&#44; This increased the questionnaire&#8217;s sensitivity and NPV&#44; particularly in patients with moderate and severe OSAS&#46; However&#44; one of the main limitations reported in the study was the refusal of many patients to undergo conventional nocturnal PSG &#40;only 177 of the 2721 patients included underwent PSG&#41;&#44; mainly because of preoperative anxiety&#44; or reluctance to spend a night in the hospital&#46; This is why other studies in STOP-BANG by the same and other authors included HPR as a diagnostic method<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Since 2008&#44; when it was first published&#44; the STOP-BANG has been validated in other subpopulations<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#58; bus drivers&#44; obese individuals&#44; pregnant women&#44; etc&#46;&#44; and its role as a screening tool to stratify perioperative risk has been the subject of numerous studies and articles&#44; mainly systematic reviews and meta-analyses&#44; some of low methodological quality&#46; All these studies&#44; however&#44; consistently reported that patients who obtain higher scores on the STOP-BANG have a greater probability of moderate and severe OSAS<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The UHN-owned STOP-bang website &#40;stopbang&#46;ca&#41; contains simple translations of the questionnaire into many different languages&#44; together with adaptation and validation studies of the STOP-bang from English to various languages&#44; such as Danish&#44; Portuguese and Chinese<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a>&#46; Although these differ methodologically&#44; they all include a preliminary translation-back-translation phase&#46; In a recent Spanish study to validate the STOP-bang for ENT specialists<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#44; the authors used the literal Spanish translation of the original&#44; updated in 2015&#44; posted on the &#171;stopnang&#46;ca&#187; website&#46; This update changes the first question of the original STOP-BANG<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#44; thus increasing its sensitivity&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">This study has several limitations&#46; It was originally designed for surgical patients&#44; but since many declined to undergo RP&#44; patients referred from primary care to a pulmonology clinic due to suspected SAHS were also recruited&#46; This selection bias was not evident when calculating the discriminant validity&#44; since the classification of patients as low and high risk SAHS according to the SBQ V1 was similar in both groups &#40;pulmonologist vs&#46; anaesthesiologist&#41;&#46; However&#44; none of the patients seen by the pulmonologist refused to undergo RP because they already had a suspected diagnosis&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">HRP was used to calculate AHI&#44; given the technical and organizational difficulties involved in performing nocturnal PSG in the HUSLL&#59; nevertheless&#44; some patients with unclear AHI results underwent confirmational PSG&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">We have continued to collect data in order to increase the size of our series and improve the statistical significance of the predictive parameters&#46; This&#44; however&#44; does not affect our initial objective or the results of our study&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0185" class="elsevierStylePara elsevierViewall">The VI version of the STOP-bang questionnaire translated&#44; adapted and validated in Spanish evaluated in this study is a reliable&#44; valid tool that is easy to understand and implement&#46; As recommended by various scientific societies focused on anaesthesiology and sleep research&#44; this questionnaire can be used to reliably stratify surgical risk and optimise perioperative planning in patients at risk of SAHS that have not been diagnosed before surgery&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Using a simple&#44; literary translation of a questionnaire previously validated in another language can lead to unreliable results that cannot be compared with other studies&#46; Instead&#44; according to the recommended methodology&#44; these questionnaires need to undergo a process of cross-cultural adaptation and validation of their most important psychometric features&#44; such as reliability and validity&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Obstructive Sleep Apnea Syndrome &#40;OSAS&#41; or Apnea-Hypoapnea Syndrome &#40;SAHS&#41; is one of the most prevalent sleep disorders in the general population&#46; It is associated with an increase in the prevalence of difficult orotracheal intubation and postoperative complications&#46; The application of validated early detection tests&#44; such the STOPbang test in English &#40;STBC&#41;&#44; is recommended&#59; a test of high methodological quality&#44; sensitivity and specificity in the early detection of SAHS in both surgical and general populations&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The validation&#44; translation&#44; cross-cultural adaptation of the STBC to the Spanish population&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The transcultural adaptation of the STBC to Spanish was carried out and a subsequent validation study with 77 consecutive patients was carried out&#46; The statistical analysis evaluated the reliability&#44; validity and feasibility of the translated and culturally adapted version&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">44&#37; of women and 56&#37; of men were included&#44; with a mean age of 53&#46;58 &#177; 12&#46;88 years&#46; The reliability results were&#58; a Cronbach&#39;s Alpha Coefficient of 0&#46;767&#44; a Pearson correlation r &#61; 0&#46;777 &#40;<span class="elsevierStyleItalic">P</span> &#60; &#46;001&#41; and a Sperman correlation rho &#61; 0&#46;455 &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;044&#41;&#46; The feasibility of the study was 100&#37;&#46; Criterion validity was evaluated using the Kappa coefficient&#44; which was 0&#46;444&#46; For a score &#62;3 of the questionnaire adapted to Spanish&#44; the results of sensitivity&#44; specificity according to the different cut-off levels of the apnea hypopnea index &#40;AHI&#41; &#62;5&#44; &#62;15&#44; &#62;30&#41; were&#58; Sensitivity 87&#37;&#44; 91&#37; and 100&#37; respectively and Specificity of 50&#37;&#44; 31&#37; and 22&#37;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The STBC questionnaire translated&#44; adapted and validated into Spanish&#44; evaluated in the present study&#44; is reliable and valid with respect to the original design of the questionnaire&#46; It is a useful tool that is easy to understand and implement&#44; which can be used rigorously to stratify surgical risk and carry out adequate perioperative planning of those patients at risk of SAHS&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduccion</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">El S&#237;ndrome de Apnea Obstructiva del Sue&#241;o &#40;SAOS&#41; o S&#237;ndrome de Apnea-Hipoapnea &#40;SAHS&#41; es uno de los trastornos del sue&#241;o m&#225;s prevalentes en la poblaci&#243;n general&#46; Est&#225; asociado a un aumento en la prevalencia de Intubaci&#243;n orotraqueal dif&#237;cil y de las complicaciones postoperatorias&#46; Se recomienda la aplicaci&#243;n de tests de detecci&#243;n precoz validados como el test en ingl&#233;s de STOPbang &#40;STBC&#41;&#59; un test de alta calidad metodol&#243;gica&#44; sensibilidad y especificidad en la detecci&#243;n precoz del SAHS tanto en la poblaci&#243;n quir&#250;rgica como general&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La validaci&#243;n&#44; traducci&#243;n y adaptaci&#243;n cultural del test STBC a la poblaci&#243;n espa&#241;ola&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y metodos</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; la adaptaci&#243;n transcultural del STBC al espa&#241;ol y un estudio de validaci&#243;n posterior con 77 pacientes consecutivos&#46; El an&#225;lisis estad&#237;stico evalu&#243; la fiabilidad&#44; validez y factibilidad de la versi&#243;n traducida y adaptada culturalmente&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 44&#37; de mujeres y 56&#37; de hombres con una edad media de 53&#44;58 &#177; 12&#44;88 a&#241;os&#46; Los resultados en la fiabilidad fueron&#58; un Coeficiente Alpha de Cronbach de 0&#44;767&#44; una correlaci&#243;n de Pearson r &#61; 0&#44;777 &#40;<span class="elsevierStyleItalic">P</span> &#60;&#44;001&#41; y una correlaci&#243;n de Sperman rho &#61; 0&#44;455 &#40;<span class="elsevierStyleItalic">P</span> &#61;&#44;044&#41;&#46; La factibilidad del estudio fue del 100&#37;&#46; La validez de criterio se evalu&#243; mediante el coeficiente Kappa que fu&#233; de 0&#44;444&#46; Para una puntuaci&#243;n &#62; 3 del cuestionario adaptado al espa&#241;ol los resultados de sensibilidad&#44; especificidad seg&#250;n los distintos niveles de corte del &#237;ndice apnea hipoapnea &#40;IAH&#41; &#62;5&#44; &#62;15&#44; &#62;30&#41; fueron&#58; Sensibilidad del 87&#37;&#44; 91&#37; y 100&#37; respectivamente y de Especificidad del 50&#37;&#44; 31&#37; y 22&#37;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">El cuestionario STBC traducido&#44; adaptado y validado al espa&#241;ol evaluado en el presente estudio&#44; es fiable y v&#225;lido con respecto al dise&#241;o original del cuestionario&#46; Es una herramienta &#250;til de f&#225;cil comprensi&#243;n e implementaci&#243;n&#44; que puede utilizarse con rigor para estratificar el riesgo quir&#250;rgico y realizar una adecuada planificaci&#243;n perioperatoria de aquellos pacientes con riesgo de SAHS&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introduccion"
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          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material y metodos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
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      ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mira Quir&#243;s MD&#44; Maim&#243; Bordoy A&#44; El Haji K&#44; Aguilar S&#225;nchez JL&#44; Tejada Gavela S&#46; Adaptaci&#243;n transcultural y validaci&#243;n del cuestionario STOP-bang del ingl&#233;s al espa&#241;ol como herramienta de detecci&#243;n precoz del s&#237;ndrome de apnea del sue&#241;o en el paciente quir&#250;rgico y en la poblaci&#243;n general&#46; Rev Esp Anestesiol Reanim&#46; 2022&#59;69&#58;393&#8211;401&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0205" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0055"
          ]
        ]
      ]
    ]
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      0 => array:8 [
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        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cross-cultural adaptation and validation of health questionnaires&#58; review and methodological recommendations&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AUC&#58; area under the curve&#59; NPV&#58; negative predictive value&#59; PPV&#58; positive predictive value&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Source&#58; adapted from Ramada-Rodilla JM et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p>"
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      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr2.jpeg"
            "Alto" => 2140
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            "Tamanyo" => 235401
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        "detalles" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Flow chart&#46; Patient selection&#46;</p>"
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        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2109
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Single-channel respiratory polygraphy results according to AHI&#46;</p>"
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      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">AHI&#58; apnoea&#47;hypopnea index&#59; ASA&#58; American Society of Anesthesia classification of anaesthesia risk according to patient status&#59; BMI&#58; body mass index&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">ASA &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASA 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASA 3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>General surgery&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Orthopaedic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ENT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ophthalmology&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">31&#46;8 &#40;32&#46;1&#8722;36&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleItalic">&#41; &#62; 35 &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#62; 50 years &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Neck circumference &#62; 40 cm &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Male gender &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">STOP-bang score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;4&#46;42&#8722;5&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Low risk on STOP-BANG &#60; 3 &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Moderate-to-high risk on STOP-BANG &#8805; 3 &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">AHI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;7 &#40;21&#46;28&#8722;33&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Bille J et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">AHI&#58; apnoea&#47;hypopnoea index&#59; AUC&#58; area under the curve&#59; NPV&#58; negative predictive value&#59; PPV&#58; positive predictive value&#59; p Mann-Whitney U&#44; 5&#37; significance level&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Data shown as percentages &#40;95&#37; confidence interval&#41;&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IAH &#62; 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IAH &#62; 15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IAH &#62; 30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Patients &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sensitivity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Specificity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AUC &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;778 &#40;0&#44;573&#8722;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;74 &#40;0&#46;60&#8722;0&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;76 &#40;0&#46;63&#8722;&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NPV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">AHI&#58; Apnoea&#47;hypopnoea index&#59; AUC&#58; Area under the curve&#59; NPV&#58; negative predictive value&#59; PPV&#58; Positive predictive value&#59; p Mann-Whitney U&#44; significance level 5&#37;&#46;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Predictive parameters of the original STOP-Bang questionnaire&#59; n &#61; 177</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">IAH &#62; 5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">IAH &#62; 15</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">IAH &#62; 30</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sensitivity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;6 &#40;75&#46;8&#8722;89&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;9 &#40;84&#46;1&#8722;97&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;91&#46;0&#8722;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Specificity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;4 &#40;42&#46;3&#8722;69&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;33&#46;5&#8722;52&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;28&#46;9&#8722;45&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AUC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;806&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;782&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;822&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;0 &#40;73&#46;0&#8722;87&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;6 &#40;42&#46;5&#8722;60&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;0 &#40;23&#46;0&#8722;39&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NPV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#46;8 &#40;46&#46;1&#8722;74&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">90&#46;2 &#40;78&#46;6&#8722;96&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;93&#46;0&#8722;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Adapted from Chung et al&#46; Anesthesiology</span> 2008&#44;108<span class="elsevierStyleBold">&#40;5&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Data shown as percentages &#40;</span>95&#37; <span class="elsevierStyleItalic">confidence interval&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">AHI&#58; Apnoea&#47;hypopnoea index&#59; AUC&#58; Area under the curve&#59; NPV&#58; negative predictive value&#59; PPV&#58; positive predictive value&#46;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
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                  \t\t\t\t">&#91;0&#46;1- <span class="elsevierStyleBold">Predictive parameters of the adapted and validated English-Danish STOP-BANG questionnaire&#59; n &#61; 43</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">IAH &#62; 5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">IAH &#62; 15</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">IAH &#62; 30</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sensitivity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;1 &#40;70&#46;1&#8722;96&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;83&#46;9&#8722;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#40;69&#46;2&#8722;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Specificity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;0 &#40;53&#46;3&#8722;90&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;1 &#40;36&#46;4&#8722;79&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">39&#46;4 &#40;22&#46;9&#8722;57&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">AUC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Data shown as percentages &#40;</span>95&#37; <span class="elsevierStyleItalic">confidence interval&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">&#91;0&#46;1-4&#93;<span class="elsevierStyleBold">Adapted from Bille J et al&#46; Dan Med J Dan Med J 2015&#59;62&#40;12&#41;&#58;1-5&#46;</span></td></tr></tbody></table>
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Article information

ISSN: 23411929
Original language: English

DOI:10.1016/j.redare.2022.07.001

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