The sawtooth sign is predictive of obstructive sleep apnea

Michael H. Bourne, Paul D Scanlon, Darrell R. Schroeder, Eric J. Olson

Research output: Contribution to journalArticle

Abstract

Background: The sawtooth sign in spirometry is associated with redundant upper airway tissue and snoring, but its predictive value for identifying obstructive sleep apnea (OSA) is disputed. We retrospectively assessed the predictive value of the spirometric sawtooth sign in terms of the odds ratio (OR) of association with a diagnosis of OSA compared to those without the sign. Methods: Consecutive spirometry reports showing a sawtooth sign were identified from our laboratory. We identified 50 subjects with sawtooth sign and 100 control subjects without sawtooth sign, matched for age, BMI, and gender. The electronic medical record of each patient was queried for a diagnosis of OSA based on physician-reported diagnoses. Results: Of the 50 subjects with sawtooth sign, 22 were found to have a current diagnosis of OSA (44%). Twenty-seven of the 100 controls (27%) also had OSA. From logistic regression analysis, sawtooth sign was associated with an increased likelihood of OSA (OR = 2.12, 95% C.I. 1.04 to 4.35). Similar results were obtained after adjustment for age, gender, pack years, and BMI (OR = 2.61, 95% C.I. 1.13 to 6.21). Conclusions: Patients with the sawtooth sign have greater odds of having a diagnosis of OSA compared with those without the sign. If prospectively evaluated, as a result of improved identification, we hypothesize that the sawtooth sign may show an even stronger association with OSA. This relatively common finding, which adds no cost to routine spirometry, may serve as an indicator for OSA workup for some individuals not already identified as having OSA.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalSleep and Breathing
DOIs
StateAccepted/In press - Nov 29 2016

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Obstructive Sleep Apnea
Spirometry
Odds Ratio
Snoring
Electronic Health Records
Logistic Models
Regression Analysis
Physicians
Costs and Cost Analysis

Keywords

  • Obstructive sleep apnea
  • Sawtooth sign
  • Smoking
  • Spirometry

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology

Cite this

The sawtooth sign is predictive of obstructive sleep apnea. / Bourne, Michael H.; Scanlon, Paul D; Schroeder, Darrell R.; Olson, Eric J.

In: Sleep and Breathing, 29.11.2016, p. 1-6.

Research output: Contribution to journalArticle

Bourne, Michael H. ; Scanlon, Paul D ; Schroeder, Darrell R. ; Olson, Eric J. / The sawtooth sign is predictive of obstructive sleep apnea. In: Sleep and Breathing. 2016 ; pp. 1-6.
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abstract = "Background: The sawtooth sign in spirometry is associated with redundant upper airway tissue and snoring, but its predictive value for identifying obstructive sleep apnea (OSA) is disputed. We retrospectively assessed the predictive value of the spirometric sawtooth sign in terms of the odds ratio (OR) of association with a diagnosis of OSA compared to those without the sign. Methods: Consecutive spirometry reports showing a sawtooth sign were identified from our laboratory. We identified 50 subjects with sawtooth sign and 100 control subjects without sawtooth sign, matched for age, BMI, and gender. The electronic medical record of each patient was queried for a diagnosis of OSA based on physician-reported diagnoses. Results: Of the 50 subjects with sawtooth sign, 22 were found to have a current diagnosis of OSA (44{\%}). Twenty-seven of the 100 controls (27{\%}) also had OSA. From logistic regression analysis, sawtooth sign was associated with an increased likelihood of OSA (OR = 2.12, 95{\%} C.I. 1.04 to 4.35). Similar results were obtained after adjustment for age, gender, pack years, and BMI (OR = 2.61, 95{\%} C.I. 1.13 to 6.21). Conclusions: Patients with the sawtooth sign have greater odds of having a diagnosis of OSA compared with those without the sign. If prospectively evaluated, as a result of improved identification, we hypothesize that the sawtooth sign may show an even stronger association with OSA. This relatively common finding, which adds no cost to routine spirometry, may serve as an indicator for OSA workup for some individuals not already identified as having OSA.",
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AB - Background: The sawtooth sign in spirometry is associated with redundant upper airway tissue and snoring, but its predictive value for identifying obstructive sleep apnea (OSA) is disputed. We retrospectively assessed the predictive value of the spirometric sawtooth sign in terms of the odds ratio (OR) of association with a diagnosis of OSA compared to those without the sign. Methods: Consecutive spirometry reports showing a sawtooth sign were identified from our laboratory. We identified 50 subjects with sawtooth sign and 100 control subjects without sawtooth sign, matched for age, BMI, and gender. The electronic medical record of each patient was queried for a diagnosis of OSA based on physician-reported diagnoses. Results: Of the 50 subjects with sawtooth sign, 22 were found to have a current diagnosis of OSA (44%). Twenty-seven of the 100 controls (27%) also had OSA. From logistic regression analysis, sawtooth sign was associated with an increased likelihood of OSA (OR = 2.12, 95% C.I. 1.04 to 4.35). Similar results were obtained after adjustment for age, gender, pack years, and BMI (OR = 2.61, 95% C.I. 1.13 to 6.21). Conclusions: Patients with the sawtooth sign have greater odds of having a diagnosis of OSA compared with those without the sign. If prospectively evaluated, as a result of improved identification, we hypothesize that the sawtooth sign may show an even stronger association with OSA. This relatively common finding, which adds no cost to routine spirometry, may serve as an indicator for OSA workup for some individuals not already identified as having OSA.

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