Combining four screening tools for cost effective screening of OSA in train drivers: A UK experience

BACKGROUND: Obstructive sleep apnoea (OSA) in drivers/workers has been implicated in railway and road traffic safety incidents; however, there are insufficient data on its prevalence and cost-effective screening methods. AIM: This pragmatic study examines four OSA screening tools: the Epworth sleepiness scale (ESS), the STOP-Bang (SB), the adjusted neck circumference (ANC) and the body mass index (BMI), exploring their suitability and effectiveness separately and in combination. METHOD: Using all four tools, 292 train drivers were opportunistically screened between 2016 and 2017. A polygraph (PG) test was carried out when OSA was suspected. Patients with an apnoea–hypopnea index (AHI) ≥5 were referred to a clinical specialist and reviewed annually. Those who had continuous positive airway pressure (CPAP) treatment were evaluated for compliance and control. RESULTS: Of the 40 patients who had PG testing, 3 and 23 participants met the ESS >10 and SB >4, criteria, respectively, whereas 25 participants each had an ANC >48 and a BMI >35 with a risk factor or ≥40 with none. OSA was detected in 3, 18 and 16 of them who met the ESS, SB and ANC criteria, respectively, and was positive for OSA in addition to 16 others who met the BMI criteria. A total of 28 (72%) were diagnosed with OSA. CONCLUSION: Although when used individually, these screening methods are less effective/inadequate, combining them is easy, feasible and offers the maximum chance of OSA detection in train drivers.