New OSA Screener Performs ‘Significantly Better’ Than Epworth, Berlin, Other Common Tools

Summary: Researchers in Australia have developed the General Practice Sleep Scale (GPSS)-OSA, a new obstructive sleep apnea screening questionnaire that significantly outperformed existing tools in a pilot study.

Key Takeaways:

GPSS-OSA performed better than existing OSA screening tools such as the Epworth Sleepiness Scale, Berlin Questionnaire, OSA-50, and STOP-Bang, reducing false negatives and unnecessary referrals.
The questionnaire is designed for ease of use, allowing patients to complete it quickly in a waiting room prior to consultation, addressing the time constraints typical of general practice.
The GPSS-OSA accounts for demographic variations, improving identification of OSA in younger adults and women, groups previously underserved by standard screening methods.

Researchers at Australia’s Charles Darwin University are developing a new screener for obstructive sleep apnea (OSA).

A pilot study published in Sleep Medicine found the new General Practice Sleep Scale (GPSS)-OSA questionnaire performed “significantly better” than existing common screening tools for OSA—including the Epworth Sleepiness Scale (ESS), Berlin Questionnaire, and OSA-50.

Featuring a broader, more inclusive scope of questions across categories including age, sex, and patient experience, the GPSS is designed to increase accessibility, ease, and accuracy. Patients can complete the questionnaire in a waiting room before a clinical appointment.

The study’s lead author, Timothy Howarth, PhD, says the GPSS-OSA was also an improvement over the STOP-Bang screening tool.

“Screening tools need to avoid two things: 1) not referring patients who do have OSA and 2) referring patients who do not have OSA,” he says in a release. “In our study, if referrals were made based on a moderate score for the STOP-Bang, 59% of patients would not be referred, and of those, 50% would have OSA.

“In contrast, using a moderate score on the GPSS, 14% of patients would not be referred, and of those 0% would actually have OSA.”

The study’s lead co-author sleep specialist Subash Heraganahally, MBBS, MD, FRACP, a professor at the Charles Darwin University School of Medicine and Royal Darwin Hospital and Darwin Respiratory Sleep Health, Darwin Private Hospital Respiratory, says, in a release, “More than 50% of patients who don’t meet the current referral criteria in Australia recorded moderate to severe OSA on completing a diagnostic polysomnography.

“In 2023, 80.8% of [general practitioner] attendances were six-to-20-minute consultations, highlighting that the time taken to fill multiple questionnaires within a consultation is likely a significant barrier to assess for OSA, let alone to further initiate specialist referrals or to undergo a sleep study.”

Noting increasing rates of obesity in Australia and an aging population, Heraganahally says some of the current screening tools—such as the STOP-Bang and OSA-50—had “significant age and gender bias” and that OSA was becoming more prevalent in at-risk younger individuals and adult women of all ages.

“Some of the existing screening tools were developed and validated predominantly to include patients over 50 years and males, and new referral guidelines for PSG should be considered,” he says.