Screening for Obstructive Sleep Apnea in Patients with Arterial Hypertension: Developmentand Internal Validation of an Exploratory Model Based on Clinical and EchocardiographicVariables

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Abstract

Background: Obstructive sleep apnea (OSA) is a recognized cause of secondary hypertension and a contributing factor to the progression of cardiovascular damage. Although its prevalence among patients with hypertension is high, it is often underdiagnosed.

Objective: To develop and internally validate a clinical predictive model, based on routine variables, to estimate the risk of OSA in patients with arterial hypertension (AH).

Methods: We analyzed a retrospective cohort of patients with AH seen in an outpatient cardiology service. Patients with complete data and a diagnostic polysomnography were included. Clinical and echocardiographic variables were evaluated, with age categorized into clinically relevant ranges. Predictor selection was performed using three methods: LASSO, Boruta, and AIC stepwise. Predictor robustness was assessed through bootstrap validation (n = 1000). Model performance was evaluated using the area under the ROC curve (AUC), performance metrics, and calibration with the Hosmer–Lemeshow test.

Results: A total of 1,795 patients were included (88 with OSA, 5%). Independent predictors were diastolic dysfunction (OR 2.39; 95% CI: 1.54–3.74), male sex (OR 2.12; 95% CI: 1.35–3.38), age 45–65 years (OR 1.71; 95% CI: 1.10–2.66), and BMI (per unit OR 1.08; 95% CI: 1.05–1.11). The model yielded an AUC of 0.70 (95% CI: 0.59–0.81), sensitivity 71%, specificity 55%, negative predictive value (NPV) 98%, and overall accuracy 56%, with good calibration.

Conclusions: This model, based on simple and readily available variables, allows OSA to be ruled out with high certainty in hypertensive patients and optimizes the use of polysomnography, representing an effective screening strategy in outpatient practice.