Evaluation of a sleep sound analysis smartphone app for home obstructive sleep apnea screening among community-dwelling Chinese adults with hypertension.

PURPOSE: This study aimed to evaluate the validity and feasibility of home obstructive sleep apnea screening using a sleep sound analysis smartphone app compared to the STOP-BANG questionnaire (SBQ) among Chinese adults with hypertension, including the impact of screening on intention to pursue treatment. METHODS: A randomized cross-over trial was conducted among adults with hypertension from a hospital clinic and community health center in Haikou, China. Participants were assigned to undergo sequential screening with a sleep sound analysis smartphone app (Snail Sleep) or the SBQ followed by home sleep apnea testing. Questionnaires measured satisfaction and intention to pursue treatment. RESULTS: Among 180 participants (median age: 51.0 years, 72.2% male), 91.7% had OSA, including 28.3% with moderate OSA, and 37.2% with severe OSA (mean AHI 28.6, SD = 23.02). An app-generated apnea index (APP-AI) optimal cutoff of 7.1 achieved 72.0% sensitivity, 85.5% specificity, a 4.96 positive likelihood ratio (LR), and a 0.33 negative LR for moderate-to-severe OSA (AHI ≥ 15), with an area under the curve (AUC) of 0.831 (95% CI 0.773-0.89), outperforming the original SBQ (BMI > 35) (AUC 0.728) and modified SBQ (BMI > 28) (AUC 0.754). Participants reported high satisfaction levels. Intention to pursue treatment decreased among those given normal screening results while remaining high among those given abnormal results. CONCLUSION: A sleep sound analysis smartphone app achieved acceptable validity and feasibility for home OSA screening in a group of Chinese adults with hypertension. Further studies should evaluate app screening in other populations and effects on patient attitudes and behavior.