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Updated: Mar 25, 2026

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
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Modified Sleep Apnea Severity Index and Cardiovascular Risk in CPAP-Intolerant OSA Patients

Praneet C Kaki1, Jennifer A Goldfarb1, Melissa Xu1

  • 1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

The Laryngoscope
|March 24, 2026
PubMed
Abstract

Insights

The modified sleep apnea severity index (mSASI) shows potential in assessing cardiovascular risk in sleep apnea patients. However, further research is needed to confirm its utility beyond individual components.

Area of Science:

  • Sleep Medicine
  • Cardiology
  • Otolaryngology

Background:

  • Obstructive Sleep Apnea (OSA) is linked to increased cardiovascular (CV) risk.
  • The modified sleep apnea severity index (mSASI) is a composite score integrating patient anatomy, weight, sleep study metrics, and symptoms.
  • Assessing the association between mSASI and CV risk factors is crucial for patient management.

Purpose of the Study:

  • To evaluate the relationship between the mSASI and cardiovascular risk factors in patients undergoing surgical treatment for OSA.
  • To determine if mSASI provides additional predictive value for CV risk beyond traditional metrics.

Main Methods:

  • Retrospective cohort review of 209 CPAP-intolerant OSA patients who underwent surgery.
  • Assessment of cardiovascular comorbidities and 5-year Framingham Risk Score (FRS) preoperatively.
  • Statistical analyses including Chi-squared and Wilcoxon rank sum tests, and multivariable linear regression.

Main Results:

  • Patients with higher mSASI scores (2 or 3) were more likely to have hypertension (p=0.011).
  • Baseline mSASI and age were independently associated with increased FRS on multivariable analysis (p<0.05).
  • This association did not persist in secondary analyses excluding constituent components of mSASI and FRS.

Conclusions:

  • The mSASI may offer supplementary value in evaluating OSA severity concerning CV risk factors compared to Apnea-Hypopnea Index (AHI) alone.
  • Further investigation is required to validate the mSASI's utility beyond its constituent factors and established metrics.
Keywords:
CPAP intolerancecardiovascular mortalitycardiovascular riskhypoglossal nerve stimulationmodified sleep apnea severity indexobstructive sleep apnea

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