Validation of NoSAS score for the screening of obstructive sleep apnea

Georgakopoulou,Vasiliki Epameinondas; Pantazis,Nikos; Tsiafaki,Xanthi; Nena,Evangelia; Amfilochiou,Anastasia; Steiropoulos,Paschalis

doi:10.3892/mi.2023.74

Validation of NoSAS score for the screening of obstructive sleep apnea

Authors:
- Vasiliki Epameinondas Georgakopoulou
- Nikos Pantazis
- Xanthi Tsiafaki
- Evangelia Nena
- Anastasia Amfilochiou
- Paschalis Steiropoulos
View Affiliations

Affiliations: Department of Infectious Diseases‑COVID‑19 Unit, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece, First Pulmonology Department, Sismanogleio Hospital, 15126 Athens, Greece, MSc in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece, Sleep Clinic, Sismanogleio Hospital, 15126 Athens, Greece
Published online on: February 22, 2023 https://doi.org/10.3892/mi.2023.74
Article Number: 14
Copyright: © Georgakopoulou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Obstructive sleep apnea (OSA) is the most common sleep‑related breathing disorder (SBD) characterized by the repetitive collapse of the upper airway during sleep. The aim of the present study was to validate the Neck circumference, Obesity, Snoring, Age, Sex (NoSAS) score in a sample population and to compare its validity for OSA screening, with that of the Berlin questionnaire, STOP‑BANG questionnaire and Epworth Sleepiness Scale (ESS). A retrospective analysis was conducted on individuals, aged 18 to 80 years, who reported symptoms indicating SBD and were examined with full‑night polysomnography (PSG) at a sleep center. Demographics, anthropometric parameters, comorbidities, ESS, STOP‑BANG questionnaire, Berlin questionnaire and PSG data were obtained from the recorded data of the patients. The NoSAS score was determined using the recorded data. A total of 347 participants were enrolled in the study. The NoSAS scores identified individuals with OSA, with an area under the curve (AUC) of 0.774. The NoSAS score performed significantly better than the Berlin questionnaire (AUC 0.617) and the ESS (AUC 0.642), and similarly to STOP‑BANG (AUC 0.777) for OSA screening. Using a NoSAS score >7 to predict OSA, the sensitivity and specificity were 85.6 and 50%, respectively; using the STOP‑BANG questionnaire, for a score >2, the values were 98.32 and 22% respectively; using the Berlin questionnaire for >1 positive categories, the values were 93.6 and 20%, and using the ESS, for a score >10, the values were 30.3% and 72%, respectively. On the whole, the present study demonstrates that the NoSAS score is a simple, efficient and easy method for screening OSA in the clinical setting. The NoSAS score performs significantly more efficiently than the Berlin questionnaire and ESS, and similarly to STOP‑BANG questionnaire for OSA screening.

View Figures

View References

1	Archontogeorgis K, Nena E, Papanas N and Steiropoulos P: Biomarkers to improve diagnosis and monitoring of obstructive sleep apnea syndrome: Current status and future perspectives. Pulm Med. 2014(930535)2014.PubMed/NCBI View Article : Google Scholar
2	Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pépin JL, et al: Estimation of the global prevalence and burden of obstructive sleep apnoea: A literature-based analysis. Lancet Respir Med. 7:687–698. 2019.PubMed/NCBI View Article : Google Scholar
3	Pafili K, Steiropoulos P and Papanas N: The relationship between obstructive sleep apnoea and coronary heart disease. Curr Opin Cardiol. 30:439–446. 2015.PubMed/NCBI View Article : Google Scholar
4	Perantoni E, Filos D, Archontogeorgis K, Steiropoulos P and Chouvarda IC: Pre-diabetic patients with severe obstructive sleep apnea: Novel parameters of hypoxia during sleep correlate with insulin resistance. Annu Int Conf IEEE Eng Med Biol Soc. 2019:5002–5005. 2019.PubMed/NCBI View Article : Google Scholar
5	Bouloukaki I, Grote L, McNicholas WT, Hedner J, Verbraecken J, Parati G, Lombardi C, Basoglu OK, Pataka A, Marrone O, et al: Mild obstructive sleep apnea increases hypertension risk, challenging traditional severity classification. J Clin Sleep Med. 16:889–898. 2020.PubMed/NCBI View Article : Google Scholar
6	Garvey JF, Pengo MF, Drakatos P and Kent BD: Epidemiological aspects of obstructive sleep apnea. J Thorac Dis. 7:920–929. 2015.PubMed/NCBI View Article : Google Scholar
7	Hong C, Chen R, Qing S, Kuang A, Yang H, Su X, Zhao D, Wu K and Zhang N: Validation of the NoSAS score for the screening of sleep-disordered breathing: A hospital-based retrospective study in China. J Clin Sleep Med. 14:191–197. 2018.PubMed/NCBI View Article : Google Scholar
8	Johns MW: A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep. 14:540–545. 1991.PubMed/NCBI View Article : Google Scholar
9	Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A and Shapiro CM: STOP questionnaire: A tool to screen patients for obstructive sleep apnea. Anesthesiology. 108:812–821. 2008.PubMed/NCBI View Article : Google Scholar
10	Netzer NC, Stoohs RA, Netzer CM, Clark K and Strohl KP: Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 131:485–491. 1999.PubMed/NCBI View Article : Google Scholar
11	Marti-Soler H, Hirotsu C, Marques-Vidal P, Vollenweider P, Waeber G, Preisig M, Tafti M, Tufik SB, Bittencourt L, Tufik S, et al: The NoSAS score for screening of sleep-disordered breathing: A derivation and validation study. Lancet Respir Med. 4:742–748. 2016.PubMed/NCBI View Article : Google Scholar
12	Tsara V, Serasli E, Amfilochiou A, Constantinidis T and Christaki P: Greek version of the Epworth sleepiness scale. Sleep Breath. 8:91–95. 2004.PubMed/NCBI View Article : Google Scholar
13	Pataka A, Chavouzis N, Passa KF, Bagalas V, Pitsiou G, Stanopoulos I, Kalamaras G, Paspala A, Sourla E, Vaitsi E and Argyropoulou P: Validation of the stop bang questionnaire in a sleep clinic in Greece for the prediction of mobstructive sleep apnea. Eur Respir J. 42(P4052)2013.
14	Bouloukaki I, Komninos ID, Mermigkis C, Micheli K, Komninou M, Moniaki V, Mauroudi E, Siafakas NM and Schiza SE: Translation and validation of Berlin questionnaire in primary health care in Greece. BMC Pulm Med. 13(6)2013.PubMed/NCBI View Article : Google Scholar
15	Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, et al: Rules for scoring respiratory events in sleep: Update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American academy of sleep medicine. J Clin Sleep Med. 8:597–619. 2012.PubMed/NCBI View Article : Google Scholar
16	Liu X: Classification accuracy and cut point selection. Stat Med. 31:2676–2686. 2012.PubMed/NCBI View Article : Google Scholar
17	Oktay Arslan B, Uçar ZZ, Batum Ö and Orman MN: Validation of the NoSAS score for screening sleep-disordered breathing: A sleep clinic- based study in Turkey. Turk J Med Sci. 51:319–327. 2021.PubMed/NCBI View Article : Google Scholar
18	Tan A, Hong Y, Tan LWL, van Dam RM, Cheung YY and Lee CH: Validation of NoSAS score for screening of sleep-disordered breathing in a multiethnic Asian population. Sleep Breath. 21:1033–1038. 2017.PubMed/NCBI View Article : Google Scholar
19	Peng M, Chen R, Cheng J, Li J, Liu W and Hong C: Application value of the NoSAS score for screening sleep-disordered breathing. J Thorac Dis. 10:4774–4781. 2018.PubMed/NCBI View Article : Google Scholar
20	Coutinho Costa J, Rebelo-Marques A, Machado JN, Gama JMR, Santos C, Teixeira F and Moita J: Validation of NoSAS (Neck, Obesity, Snoring, Age, Sex) score as a screening tool for obstructive sleep apnea: Analysis in a sleep clinic. Pulmonology. 25:263–270. 2019.PubMed/NCBI View Article : Google Scholar
21	Herschmann S, Berger M, Haba-Rubio J and Heinzer R: Comparison of NoSAS score with Berlin and STOP-BANG scores for sleep apnea detection in a clinical sample. Sleep Med. 79:113–116. 2021.PubMed/NCBI View Article : Google Scholar
22	Chen H, Zheng Z, Chen R, Zeng Y, Li N, Zhu J, Zhong Y, Liu H, Lu J, Zhang N and Hong C: A meta-analysis of the diagnostic value of NoSAS in patients with sleep apnea syndrome. Sleep Breath. 26:519–531. 2022.PubMed/NCBI View Article : Google Scholar