Obstructive sleep apnea (OSA) is garnering ever-growing respect from clinicians who recognize it is responsible for diverse toxicities beyond simple sleep disruption: hypertension, cardiac arrhythmia, auto accidents, and excessive daytime sleepiness among them. Clinicians tend to uncover OSA when persons of “typical” phenotype (overweight mid-life men and women) present with associated symptoms. Sometimes, the consequence of OSA triggers an evaluation, even in the absence of overt OSA symptoms, such as the recent observation that among persons with resistant hypertension and no history or overt stigmata of OSA, sleep studies were positive for OSA in more than 80%!
Not everyone can afford a sleep study, so clinicians would like to identify simple methods to refine the pretest probability of OSA. The elbow sign may be just such an intervention.
Fenton et al provide data on asking patients referred for a sleep study two questions: 1) Does your bed partner ever poke or elbow you because you are snoring? or 2) Does your bed partner ever poke or elbow you because you have stopped breathing?
Persons who answered affirmatively to either question were 4-6 times more likely to emerge with sleep studies that were positive for OSA. Correction for other OSA-related items (body mass index, Epworth Sleepiness Scale, etc.) did not alter this relationship.
These two simple questions may help identify patients most likely to benefit from a sleep study investigation.
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