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.
Obstructive sleep apnea (OSA) is a common disorder characterized by severe daytime sleepiness and repeated episodes of upper airway obstruction while sleeping (
A full-night polysomnography (PSG) in a sleep clinic is the gold standard for detecting OSA. However, this is not advised as a typical screening approach as it is time-consuming and costly (
Thus, a rapid and reliable screening procedure for high-risk populations is still required. The selection of a screening technique will depend on the capability to achieve a specific goal: To include patients with OSA for proper sleep testing, to identify those with more severe disease in order to enable early diagnosis and treatment, and to exclude patients without OSA or with mild OSA, whose assessment and treatment are less urgent.
A number of clinical scores, including the STOP-BANG questionnaire, Epworth Sleepiness Scale (ESS) and Berlin questionnaire, are currently being used as screening tools. The ESS is utilized for OSA, even though it was designed to assess the severity of subjective daytime sleepiness. The ESS questionnaire requests individuals to rate their likelihood of dozing off in eight distinct settings, on a range from 0 to 3. The soporific quality of these scenarios was the deciding factor in their selection (
The Lausanne Neck circumference, Obesity, Snoring, Age, Sex (NoSAS) score test, a simple, effective and practical tool that identifies those at risk of OSA, has recently been proposed as a screening tool (
The EES, STOP-BANG and Berlin questionnaires have all been previously validated as screening tools for OSA in Greek patients (
The present study retrospectively analyzed individuals who had previously undergone a full-night PSG between October 1, 2018 and November 30, 2021 at the Sleep Clinic of the Sismanogleio Hospital, Athens, Greece. The Institutional Review Board and the Independent Department of Quality, Research, and Continuing Education of Sismanogleio Hospital approved the research protocol (5974/05.04.2021 and 8077/16/04/2021, respectively). All patients provided written informed consent for inclusion in the study. All participants were suspected of having OSA. The criteria for inclusion were as follows: i) An age >18 years; ii) not previously diagnosed or treated for OSA; iii) available comprehensive anthropometric and demographic data regarding ESS, and STOP-BANG and Berlin questionnaires; and iv) a sleep efficacy ≥60%. The exclusion criteria were the following: Individuals with an active psychiatric disorder; a history of brain tumors; a history of epilepsy; a history of benzodiazepine use; patients unable to read and/or write; individuals with alternative diagnoses, i.e., central sleep apnea and obesity/hypoventilation syndrome; and all patients with PSG assessment with technical errors during data collection.
In the present study, demographics such as age and sex, anthropometric parameters such as height, weight, BMI and neck circumference, scores of ESS, STOP-BANG questionnaire, Berlin questionnaire, and PSG data such as the apnea-hypopnea index (AHI) were obtained from the recorded data of the patients. All questionnaires were completed at the same time and independently by all patients. The comorbidities of all individuals were also noted. The NoSAS score was determined with the use of the recorded data of the participants.
The ESS consists of eight questions with a four-point Likert response scale (0-3) and a score range of 0-24. A score of 10 on the ESS suggests a high risk of OSA and excessive daytime sleepiness (
The NoSAS score was first translated into Greek by a professional translation company. The translated score was then translated back into English by clinicians who were proficient in the language. The clinicians determined on the final version of the translated score. A NoSAS score ≥8 is suggestive of being at high risk for OSA (
The diagnosis of OSA was made using a PSG. Electromyography of the chin and the leg, electrooculography, electroencephalography, oxygen saturation, electrocardiography, abdominal and thoracic respiratory effort, body position and air flow (nasal pressure transducer and oronasal thermistor), and tracheal microphone were recorded using the Respironics Alice 6 LDx Diagnostic Sleep System (Philips).
PSG data were evaluated by a physician who is a sleep disorders specialist and who was blinded to the results of the NoSAS questionnaire. The American Academy of Sleep Medicine (AASM) criteria were used to score the sleep and respiratory events (
The demographic, anthropometric and clinical characteristics of the study participants were summarized using either their mean and standard deviation (SD) and median (range) for continuous variables, or absolute (N) and relative (%) frequencies, for categorical ones. Differences in the distributions of these characteristics across different categories of OSA severity were assessed using one-way ANOVA for continuous variables with normal distribution and using the Kruskal-Wallis test for variables with a non-normal distribution, and for categorical variables using the Chi-squared or Fisher's exact test.
Receiver operating characteristic (ROC) analysis was performed for all four scores under investigation. The corresponding results include graphs of the ROC curve and graphs of sensitivity and specificity vs. varying values of the score's cut-off. Results are also presented in tabular form where sensitivity, specificity, percentage of correct classification, positive predictive value (PPV) and NPV are given for the optimal cut-off value.
The optimal cut-off value for each score was derived using the method proposed by Liu (
A total of 347 participants, 243 males and 104 females, were included in the present study, of whom 96 (27.7%) were aged ≥65 years and 251 (72.3%) were aged <65 years. Of the participants, 50 (14.4%) were not diagnosed with OSA, while 15 (4.3%) were diagnosed with mild OSA, 30 (8.6%) were diagnosed with moderate OSA and 252 (72.6%) were diagnosed with severe OSA. The characteristics of the study population based on OSA severity are presented in
By performing ROC analysis, the discriminative ability of the NoSAS score for moderate and severe OSA was found to be excellent [area under the curve (AUC), 0.746] (
Using the NoSAS score, for scores >7 to predict moderate and severe OSA, the sensitivity and specificity were 86.88 and 46.15%, respectively. The optimal cut-off value was >11, where the sensitivity and specificity were 59.2 and 78.4%, respectively, the PPV was 92.27% and the NPV was 30.72%. The percentage of correct classification was 62.82%.
The discriminative ability of the NoSAS score for all severity categories of OSA was also excellent (AUC, 0.773) (
Using the STOP-BANG questionnaire, for scores >2 to predict moderate and severe OSA, the sensitivity and specificity were 98.94 and 20%, respectively. The optimal cut-off value was >4, where the sensitivity and specificity were 73.4 and 67.6%, respectively, the PPV was 90.79% and the NPV was 36.97%. The percentage of correct classification was 72.33%. The discriminative ability of the STOP-BANG questionnaire for all severity categories of OSA was also excellent (AUC, 0.776) (
Using the STOP-BANG questionnaire for scores >2 to predict OSA (all severity categories), the sensitivity and specificity were 98.32 and 22%, respectively. The optimal cut-off value was >4, where the sensitivity and specificity were 71.3 and 68%, respectively, the PPV was 92.98% and the NPV was 28.57%. The percentage of correct classification was 70.89%.
Using the ESS, for score >10 to predict OSA (all severity categories), sensitivity and specificity were 30.3 and 72%, respectively. The optimal cut-off value was >7, where the sensitivity and specificity were 50.5 and 56%, respectively, the PPV was 87.21% and the NPV was 16%. The percentage of correct classification was 51.3%.
Using the Berlin questionnaire score, for a score >1 to predict OSA (all severity categories), the sensitivity and specificity were 93.6 and 20%, respectively. The optimal cut-off value was >2, where the sensitivity and specificity were 54.2 and 64%, respectively, the PPV was 89.94% and the NPV was 19.05%. The percentage of correct classification was 55.62%.
The NOSAS and STOP-BANG scores clearly performed better in detecting moderate and severe OSA, and in detecting OSA of all severity categories, compared to the ESS and the Berlin score with a very slight superiority of STOP-BANG.
A statistically significant difference was observed in the AUC of all scores for the detection of moderate and severe OSA and for the detection of OSA of all severity categories (P<0.001). There was no statistically significant difference between the AUC of NoSAS and the AUC of STOP-BANG for the detection of moderate and severe OSA, and for the detection of OSA of all severity categories (P=0.488 and P=0.999, respectively) (
The NoSAS score was first created and validated using participants from a population in Lausanne, Switzerland (HypnoLaus cohort) and was separately validated in a population undergoing PSG due to indicating symptoms (EPISONO cohort) (
In a study from a Turkish Sleep Unit for the detection of OSA of all severity categories, the sensitivity, specificity, PPV and NPV of the NoSAS score ≥8 were 81, 51.2, 88.2 and 37.5%, respectively (
In another study on a multi-ethnic Asian cohort, the sensitivity, specificity, and NPV and PPV of the NoSAS score ≥8 for predicting severe OSA were 69.2, 73.1, 95.2 and 23.7%, respectively (
In a large study from China, the AUC for the NoSAS score for predicting moderate and severe OSA was 0.707(
In a study from Portugal with 294 participants, using the NoSAS score to predict OSA of all severity categories, moderate/severe OSA and severe OSA, a score of 12 had the optimal performance, an AUC 0.770, a sensitivity of 57.5% and a specificity of 83%. In the same study, using the STOP-BANG score to predict OSA of all severity categories, moderate/severe OSA and severe OSA, a score of 5 had the best performance with an AUC of 0.813, sensitivity of 77.3% and specificity of 66.1% (
Of particular interest is a meta-analysis of 10 studies, involving a total of 14,510 patients, which demonstrated that the NoSAS score for the detection of OSA of all severity categories was satisfactorily with an AUC of 0.770, similar to the present study. The same meta-analysis demonstrated that the NoSAS score ≥8 had a sensitivity of 79.8% and a specificity of 58.2% for the detection of OSA of all severity categories, while in our study, the corresponding sensitivity is 85.86% and the specificity 50% (
The present study had certainly some limitations. The study was conducted retrospectively, and NoSAS scores were calculated based on different answers previously given by the patients, a fact that may have an effect on the studied performance of the scores. In addition, the present study sample was derived from a single sleep clinic in Greece, which limits the generalization of conclusions for the entire Greek population.
In conclusion, the present study demonstrates that the NoSAS score is a simple, effective, and easy method for the detection of OSAS in clinical practice in the Greek population. The NoSAS score performs similarly to well-established questionnaires, such as the Berlin questionnaire, the ESS and the STOP BANG questionnaire, for the detection of OSA of all severity categories and of moderate-to-severe-severe OSA in particular.
Not applicable.
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
PS and AA conceptualized the study. VEG, XT, NP, AA and EN made a substantial contribution to data interpretation and analysis, and wrote and prepared the draft of the manuscript. PS and AA analyzed the data and provided critical revisions. VEG and AA confirm the authenticity of all the raw data. All authors contributed to manuscript revision, and have read and approved the final version of the manuscript.
The present study was conducted in line with the Declaration of Helsinki and gained approval by the regional Institutional Review Board (protocol no. 5974/05.04.2021). Written informed was obtained from all patients.
Not applicable.
The authors declare that they have no competing interests.
(A) ROC curve of the NoSAS score predicting moderate and severe OSA, and (B) ROC curve of the NoSAS score predicting OSA of all severity categories. OSA, obstructive sleep apnea; ROC, receiver operating characteristic; NoSAS, Neck circumference, Obesity, Snoring, Age, Sex.
(A) ROC curve of the STOP-BANG score predicting moderate and severe OSA, and (B) ROC curve of the STOP-BANG score predicting OSA of all severity categories. OSA, obstructive sleep apnea; ROC, receiver operating characteristic.
(A) ROC curve of the ESS score predicting moderate and severe OSA, and (B) ROC curve of the ESS score predicting OSA of all severity categories. ESS, Epworth Sleepiness Scale; OSA, obstructive sleep apnea; ROC, receiver operating characteristic.
(A) ROC curve of the Berlin questionnaire score predicting moderate and severe OSA, and (B) ROC curve of the Berlin questionnaire score predicting OSA of all severity categories. OSA, obstructive sleep apnea; ROC, receiver operating characteristic.
Population characteristics by OSA severity.
Variable | No OSA, n=50 (14.4%) | Mild, n=15 (4.3%) | Moderate, n=30 (8.6%) | Severe, n=252 (72.6%) | Overall, n=347 (100%) | P-value |
---|---|---|---|---|---|---|
Age, years; mean (SD) |
47.4 (14.3) | 53.5 (13.8) | 56.6 (11.0) | 57.6 (13.2) | 55.8 (13.7) | <0.001 |
Height, cm; mean (SD) |
168.2 (9.9) | 173.6 (12.8) | 164.7 (7.0) | 170.8 (9.7) | 170.0 (9.8) | 0.104 |
Weight, kg; mean (SD) |
88.0 (21.8) | 91.9 (10.8) | 88.5 (15.7) | 98.7 (19.2) | 96.0 (19.5) | <0.001 |
BMI, kg/m2; mean (SD) |
31.3 (8.1) | 30.8 (4.6) | 32.7 (6.3) | 33.9 (6.0) | 33.3 (6.4) | <0.001 |
Neck circumference, cm; median (range) |
37.0 (34.0-40.0) | 40.0 (38.0-41.0) | 37.5 (35.0-41.0) | 41.0 (39.0-43.0) | 40.0 (38.0-42.0) | <0.001 |
Sex, n (%) |
<0.001 | |||||
Male | 24 (48.0%) | 10 (66.7%) | 13 (43.3%) | 196 (77.8%) | 243 (70.0%) | |
Female | 26 (52.0%) | 5 (33.3%) | 17 (56.7%) | 56 (22.2%) | 104 (30.0%) | |
Age, n (%) |
0.003 | |||||
<65 | 45 (90.0%) | 10 (66.7%) | 24 (80.0%) | 172 (68.3%) | 251 (72.3%) | |
≥65 | 5 (10.0%) | 5 (33.3%) | 6 (20.0%) | 80 (31.7%) | 96 (27.7%) | |
BMI, n (%) |
<0.001 | |||||
<25 | 12 (24.0%) | 0 (0.0%) | 1 (3.3%) | 13 (5.2%) | 26 (7.5%) | |
25-29 | 14 (28.0%) | 6 (40.0%) | 9 (30.0%) | 50 (19.8%) | 79 (22.8%) | |
≥30 | 24 (48.0%) | 9 (60.0%) | 20 (66.7%) | 189 (75.0%) | 242 (69.7%) | |
Hypertension, n (%) |
0.001 | |||||
No | 33 (66.0%) | 12 (80.0%) | 15 (50.0%) | 113 (44.8%) | 173 (49.9%) | |
Yes | 17 (34.0%) | 3 (20.0%) | 15 (50.0%) | 139 (55.2%) | 174 (50.1%) | |
Snoring, n (%) |
<0.001 | |||||
No | 7 (14.0%) | 1 (6.7%) | 1 (3.3%) | 4 (1.6%) | 13 (3.7%) | |
Yes | 43 (86.0%) | 14 (93.3%) | 29 (96.7%) | 248 (98.4%) | 334 (96.3%) | |
Feeling tired, n (%) |
0.493 | |||||
No | 11 (22.0%) | 3 (20.0%) | 3 (10.0%) | 40 (15.9%) | 57 (16.4%) | |
Yes | 39 (78.0%) | 11 (73.3%) | 27 (90.0%) | 211 (83.7%) | 288 (83.0%) | |
N/A | 0 (0.0%) | 1 (6.7%) | 0 (0.0%) | 1 (0.4%) | 2 (0.6%) | |
Apnea, n (%) |
<0.001 | |||||
No | 20 (40.0%) | 8 (53.3%) | 6 (20.0%) | 46 (18.3%) | 80 (23.1%) | |
Yes | 30 (60.0%) | 7 (46.7%) | 24 (80.0%) | 206 (81.7%) | 267 (76.9%) |
aFor these variables the comparison between different categories was made using one-way ANOVA;
bfor these variables the comparison between different categories was made using the Kruskal-Wallis test;
cfor these variables the comparison between different categories was made using the Chi-squared test;
dfor these variables the comparison between different categories was made using Fischer' test. BMI, body mass index; OSA, obstructive sleep apnea; SD, standard deviation.
Scale scores and categories by OSA severity.
Variable | No OSA, n=50 (14.4%) | Mild, n=15 (4.3%) | Moderate, n=30 (8.6%) | Severe, n=252 (72.6%) | Overall, n=347 (100%) | P-value |
---|---|---|---|---|---|---|
NoSAS score, median (range) |
7.5 (7.0-11.0) | 11.0 (7.0-13.0) | 11.0 (7.0-11.0) | 13.0 (11.0-17.0) | 13.0 (9.0-15.0) | <0.001 |
STOP BANG score, median (range) |
4.0 (3.0-5.0) | 4.0 (3.0-5.0) | 4.5 (4.0-6.0) | 6.0 (5.0-6.0) | 5.0 (4.0-6.0) | <0.001 |
ESS score, median (range) |
7.0 (4.0-11.0) | 6.0 (3.0-9.0) | 8.0 (6.0-12.0) | 7.0 (4.0-11.0) | 7.0 (4.0-11.0) | 0.382 |
BQ score, mean (SD) |
2.1 (0.8) | 2.0 (0.8) | 2.5 (0.6) | 2.5 (0.6) | 2.4 (0.7) | <0.001 |
AHI (episodes/h), median (range) |
1.1 (0.0-2.7) | 13.2 (7.9-14.6) | 24.3 (19.7-27.2) | 64.3 (49.5-79.8) | 54.6 (27.2-75.2) | <0.001 |
NoSAS category, n (%) |
<0.001 | |||||
Low risk for OSA | 25 (37.9%) | 5 (7.6%) | 7 (10.6%) | 29 (43.9%) | 66 (100.0%) | |
High risk for OSA | 25 (8.9%) | 10 (3.6%) | 23 (8.2%) | 223 (79.4%) | 281 (100.0%) | |
STOP BANG category, n (%) |
<0.001 | |||||
Low risk for OSA | 11 (68.8%) | 2 (12.5%) | 1 (6.3%) | 2 (12.5%) | 16 (100.0%) | |
High risk for OSA | 39 (11.8%) | 13 (3.9%) | 29 (8.8%) | 250 (75.5%) | 331 (100.0%) | |
ESS category, n (%) | 0.145 | |||||
Normal sleepiness | 36 (14.9%) | 15 (6.2%) | 21 (8.7%) | 169 (70.1%) | 241 (100.0%) | |
Mild/moderate excessive sleepiness | 7 (10.1%) | 0 (0.0%) | 8 (11.6%) | 54 (78.3%) | 69 (100.0%) | |
Severe excessive sleepiness | 7 (18.9%) | 0 (0.0%) | 1 (2.7%) | 29 (78.4%) | 37 (100.0%) | |
BQ category, n (%) | 0.001 | |||||
Low risk for OSA | 10 (34.5%) | 3 (10.3%) | 2 (6.9%) | 14 (48.3%) | 29 (100.0%) | |
High risk for OSA | 40 (12.6%) | 12 (3.8%) | 28 (8.8%) | 238 (74.8%) | 318 (100.0%) |
Note that the percentages are calculated over rows.
aFor these variables the comparison between different categories was made using the Kruskal-Wallis test;
bfor these variables the comparison between different categories was made using one-way ANOVA;
cfor these variables the comparison between different categories was made using the Chi-squared test;
dfor these variables the comparison between different categories was made using Fischer' test. AHI, apnea hypopnea index; BQ, Berlin questionnaire; ESS, Epworth Sleepiness Scale; OSA, obstructive sleep apnea; NoSAS, Neck circumference, Obesity, Snoring, Age, Sex.
NoSAS, STOP-BANG, Berlin questionnaire and ESS score vs. moderate and severe OSA and OSA of all severity categories: Sensitivity and specificity for various cut-off values.
Moderate and severe OSA | ||
---|---|---|
NoSAS score | Sensitivity (%) | Specificity (%) |
2 | 99.29 | 4.62 |
3 | 99.29 | 6.15 |
4 | 98.94 | 7.69 |
5 | 97.52 | 15.38 |
6 | 97.16 | 18.46 |
7 | 86.88 | 46.15 |
8 | 84.04 | 47.69 |
9 | 75.89 | 60.00 |
11 | 59.22 | 78.46 |
13 | 32.98 | 90.77 |
15 | 24.82 | 93.85 |
17 | 0.00 | 100.00 |
OSA of all severity categories | ||
NoSAS score | Sensitivity (%) | Specificity (%) |
2 | 99.33 | 6.00 |
3 | 99.33 | 8.00 |
4 | 98.99 | 10.00 |
5 | 97.64 | 20.00 |
6 | 97.31 | 24.00 |
7 | 85.86 | 50.00 |
8 | 83.16 | 52.00 |
9 | 75.08 | 66.00 |
11 | 57.91 | 82.00 |
13 | 32.32 | 94.00 |
15 | 24.24 | 96.00 |
17 | 0.00 | 100.00 |
Moderate and severe OSA | ||
STOP-BANG score | Sensitivity (%) | Specificity (%) |
1 | 100.00 | 6.15 |
2 | 98.94 | 20.00 |
3 | 92.91 | 43.08 |
4 | 73.40 | 67.69 |
5 | 49.29 | 90.77 |
6 | 19.50 | 93.85 |
7 | 4.96 | 98.46 |
8 | 0.00 | 100.00 |
OSA of all severity categories | ||
STOP-BANG score | Sensitivity (%) | Specificity (%) |
1 | 100.00 | 8.00 |
2 | 98.32 | 22.00 |
3 | 91.25 | 44.00 |
4 | 71.38 | 68.00 |
5 | 47.47 | 92.00 |
6 | 18.86 | 94.00 |
7 | 4.71 | 98.00 |
8 | 0.00 | 100.00 |
Moderate and severe OSA | ||
ESS score | Sensitivity (%) | Specificity (%) |
0 | 96.45 | 1.54 |
1 | 92.91 | 9.23 |
2 | 88.30 | 12.31 |
3 | 79.79 | 21.54 |
4 | 71.28 | 30.77 |
5 | 65.60 | 33.85 |
6 | 57.80 | 49.23 |
7 | 51.06 | 56.92 |
8 | 44.33 | 60.00 |
9 | 38.30 | 66.15 |
10 | 31.91 | 78.46 |
11 | 24.11 | 81.54 |
12 | 18.44 | 84.62 |
13 | 12.77 | 87.69 |
14 | 11.35 | 89.23 |
15 | 10.28 | 89.23 |
16 | 8.16 | 90.77 |
17 | 6.38 | 95.38 |
18 | 3.19 | 96.92 |
19 | 2.48 | 98.46 |
20 | 1.77 | 98.46 |
21 | 0.71 | 100.00 |
22 | 0.00 | 100.00 |
OSA of all severity categories | ||
ESS score | Sensitivity (%) | Specificity (%) |
0 | 96.63 | 2.00 |
1 | 92.59 | 8.00 |
2 | 87.88 | 10.00 |
3 | 79.46 | 20.00 |
4 | 71.38 | 32.00 |
5 | 65.32 | 32.00 |
6 | 56.90 | 46.00 |
7 | 50.51 | 56.00 |
8 | 43.77 | 58.00 |
OSA of all severity categories | ||
ESS score | Sensitivity (%) | Specificity (%) |
9 | 37.37 | 62.00 |
10 | 30.30 | 72.00 |
11 | 22.90 | 76.00 |
12 | 17.51 | 80.00 |
13 | 12.12 | 84.00 |
14 | 10.77 | 86.00 |
15 | 9.76 | 86.00 |
16 | 7.74 | 88.00 |
17 | 6.06 | 94.00 |
18 | 3.03 | 96.00 |
19 | 2.36 | 98.00 |
20 | 1.68 | 98.00 |
21 | 0.67 | 100.00 |
22 | 0.00 | 100.00 |
Moderate and severe OSA | ||
BQ score | Sensitivity (%) | Specificity (%) |
0 | 100.00 | 4.62 |
1 | 94.33 | 20.00 |
2 | 55.67 | 66.15 |
3 | 0.00 | 100.00 |
OSA of all severity categories | ||
BQ score | Sensitivity (%) | Specificity (%) |
0 | 99.66 | 4.00 |
1 | 93.60 | 20.00 |
2 | 54.21 | 64.00 |
3 | 0.00 | 100.00 |
BQ, Berlin questionnaire; ESS, Epworth Sleepiness Scale; OSA, obstructive sleep apnea; NoSAS, Neck circumference, Obesity, Snoring, Age, Sex.
Area under the ROC curve for all scores and equality tests.
Moderate and severe OSA | |||
---|---|---|---|
Score | AUC (95% CI) | P-value (vs. NoSAS) | Global test P-value |
NoSAS | 0.746 (0.680-0.813) | Reference | <0.001 |
STOP-BANG | 0.783 (0.720-0.847) | 0.488 | |
ESS | 0.532 (0.456-0.609) | <0.001 | |
BQ | 0.636 (0.565-0.707) | 0.011 | |
OSA of all severity categories | |||
Score | AUC (95% CI) | P-value (vs. NoSAS) | Global test P-value |
NoSAS | 0.774 (0.705-0.843) | Reference | <0.001 |
STOP-BANG | 0.777 (0.705-0.848) | 0.999 | |
ESS | 0.502 (0.414-0.590) | <0.001 | |
BQ | 0.617 (0.536-0.698) | <0.001 |
BQ, Berlin questionnaire; ESS, Epworth Sleepiness Scale; OSA, obstructive sleep apnea; NoSAS, Neck circumference, Obesity, Snoring, Age, Sex; ROC, receiver operating characteristic.