Novel predictive score for sleep disordered breathing in Asians: the Nagahama study

Early detection of sleep disordered breathing (SDB) is limited by the insufficient accuracy of current screening tools, especially for Asians. This study aimed to clarify factors associated with SDB and develop an objective risk score for Asian populations.

We conducted a cross-sectional analysis of community participants from the Nagahama study in Japan, including 6375 people in the discovery cohort and 1338 people in the validation cohort. SDB was assessed by the 3% oxygen desaturation index corrected for sleep duration obtained by wrist actigraphy (Acti-ODI3%) over ≥2 nights, and moderate-to-severe SDB was defined as Acti-ODI3% ≥ 15/h. A risk scoring system was developed using weighted predictors.

Independent predictors of moderate-to-severe SDB included Hypertension (1 point), older Age (≥60 years; 2 point), Nocturia frequency (1 to <2/≥2 times/day; 1/2 points), Diabetes (1 point), reported Snoring (2 points), Obesity (body mass index 22.5 to <25/≥25 kg/m²; 1/3 points), and MEn (2 points). The HANDSOME score, comprising these seven factors, demonstrated a strong linear association with SDB prevalence (P for trend <0.001). At a cutoff of 3 points, the sensitivity and specificity of the score were 97.4% and 43.0%, respectively (area under the curve = 0.833). Meanwhile, an 8-point cutoff optimized specificity (93.5%) but lowered sensitivity (36.2%). The diagnostic accuracy of the score was comparable between the validation and discovery cohorts.

The HANDSOME score is a simple and practical tool tailored for Asian populations that effectively identifies individuals at high risk of moderate-to-severe SDB.