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Cheeks appearance as a novel predictor of obstructive sleep apnea: the CASA score study
Aline Prikladnicki1, Erissandra Gomes2, Laura Caroline Côrtes Reis Sousa1
1Cardiology Department, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
Summary
Cheeks appearance, assessed by the CASA score, shows promise as a novel predictor for obstructive sleep apnea (OSA). This simple visual assessment could aid in identifying individuals at risk for OSA.
Area of Science:
- Sleep Medicine
- Diagnostic Accuracy
- Ophthalmology
Background:
- Established obstructive sleep apnea (OSA) risk factors include BMI, age, sex, and neck circumference.
- Cheeks appearance has been previously suggested as a potential predictor, possibly integrating multiple risk factors.
- The Cheeks Appearance for Sleep Apnea (CASA) score was developed to quantify this feature.
Purpose of the Study:
- To determine if cheeks appearance, quantified by the CASA score, is a predictor of obstructive sleep apnea (OSA) risk.
- To evaluate the diagnostic accuracy of the CASA score in identifying OSA.
Main Methods:
- A prospective, cross-sectional diagnostic accuracy study adhering to STARD guidelines.
- Patients undergoing polysomnography for sleep complaints were assessed using the CASA score (0-6), based on cheeks volume and flaccidity.
- Three independent evaluators blinded to patient outcomes scored cheeks appearance.
Main Results:
- Of 248 included patients, 177 were diagnosed with OSA via polysomnography.
- A high proportion of OSA patients (167/177) had an altered CASA score (1-6).
- The CASA score demonstrated a sensitivity of 87%, specificity of 82%, and overall accuracy of 86% for OSA detection.
Conclusions:
- The CASA score, combining cheeks volume and flaccidity, appears to be a reliable predictor of OSA.
- This novel diagnostic tool shows internal validity within a sleep laboratory setting.
- Further research is recommended to confirm the external validity and clinical utility of the CASA score.
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