{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:21:08Z","timestamp":1790799668229,"version":"4.1.0"},"reference-count":42,"publisher":"BMJ","issue":"9","funder":[{"name":"Australasian Spinal Cord Injury Network"},{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Stoke-Mandeville Research Trust"},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Obstructive sleep apnoea (OSA) is highly prevalent in people with spinal cord injury (SCI). Polysomnography (PSG) is the gold-standard diagnostic test for OSA, however PSG is expensive and frequently inaccessible, especially in SCI. A two-stage model, incorporating a questionnaire followed by oximetry, has been found to accurately detect moderate to severe OSA (MS-OSA) in a non-disabled primary care population. This study investigated the accuracy of the two-stage model in chronic tetraplegia using both the original model and a modified version for tetraplegia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An existing data set of 78 people with tetraplegia was used to modify the original two-stage model. Multivariable analysis identified significant risk factors for inclusion in a new tetraplegia-specific questionnaire. Receiver operating characteristic (ROC) curve analyses of the questionnaires and oximetry established thresholds for diagnosing MS-OSA. The accuracy of both models in diagnosing MS-OSA was prospectively evaluated in 100 participants with chronic tetraplegia across four international SCI units.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Injury completeness, sleepiness, self-reported snoring and apnoeas were included in the modified questionnaire, which was highly predictive of MS-OSA (ROC area under the curve 0.87 (95% CI 0.79 to 0.95)). The 3% oxygen desaturation index was also highly predictive (0.93 (0.87\u20130.98)). The two-stage model with modified questionnaire had a sensitivity and specificity of 83% (66\u201393) and 88% (75\u201394) in the development group, and 77% (65\u201387) and 81% (68\u201390) in the validation group. Similar results were demonstrated with the original model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Implementation of this simple alternative to full PSG could substantially increase the detection of OSA in patients with tetraplegia and improve access to treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p>Results, ACTRN12615000896572 (The Australian and New Zealand Clinical Trials Registry) and pre-results, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT02176928\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial pre-results\">NCT02176928<\/jats:ext-link> (clinicaltrials.gov).<\/jats:p><\/jats:sec>","DOI":"10.1136\/thoraxjnl-2017-211131","type":"journal-article","created":{"date-parts":[[2018,5,7]],"date-time":"2018-05-07T16:21:44Z","timestamp":1525710104000},"page":"864-871","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Diagnostic accuracy of a two-stage model for detecting obstructive sleep apnoea in chronic tetraplegia"],"prefix":"10.1136","volume":"73","clinical-trial-number":[{"clinical-trial-number":"nct02176928","registry":"10.18810\/clinical-trials-gov","type":"preResults"},{"clinical-trial-number":"nct02176928","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Marnie","family":"Graco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Schembri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Cross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinnaya","family":"Thiyagarajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirin","family":"Shafazand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najib T","family":"Ayas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark S","family":"Nash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viet H","family":"Vu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren R","family":"Ruehland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching Li","family":"Chai-Coetzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Rochford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Churchward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally E","family":"Green","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Berlowitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,5,7]]},"reference":[{"key":"2020050723441944000_73.9.864.1","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.smrv.2012.12.005","article-title":"Sleep disorders in patients with spinal cord injury","volume":"17","author":"Giannoccaro","year":"2013","journal-title":"Sleep Med Rev"},{"key":"2020050723441944000_73.9.864.2","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1016\/j.apmr.2012.02.016","article-title":"Relationships between objective sleep indices and symptoms in a community sample of people with tetraplegia","volume":"93","author":"Berlowitz","year":"2012","journal-title":"Arch Phys Med Rehabil"},{"key":"2020050723441944000_73.9.864.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2006.12.025"},{"key":"2020050723441944000_73.9.864.4","doi-asserted-by":"crossref","first-page":"65","DOI":"10.5664\/jcsm.3362","article-title":"Sleep disordered breathing in chronic spinal cord injury","volume":"10","author":"Sankari","year":"2013","journal-title":"JCSM"},{"key":"2020050723441944000_73.9.864.5","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S2213-2600(15)00043-0","article-title":"Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study","volume":"3","author":"Heinzer","year":"2015","journal-title":"Lancet Respir Med"},{"key":"2020050723441944000_73.9.864.6","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3100563"},{"key":"2020050723441944000_73.9.864.7","doi-asserted-by":"crossref","unstructured":"Schembri R , Spong J , Graco M , et al . 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