Validation of NoSAS score for the screening of obstructive sleep apnea

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.