SNORES Classification: Multicenter Prospective Validation for Obstructive Sleep Apnea

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Clinical Classification Systems

Background:

• Obstructive sleep apnea (OSA) diagnosis traditionally relies on the apnea-hypopnea index (AHI).
• The AHI alone may not fully capture the heterogeneity of OSA severity and treatment response.
• A multidimensional approach is needed for precise OSA management.

Purpose of the Study:

• To validate the SNORES (Severity of apnea-hypopnea index, Nasal airflow limitation, Oxygen desaturation burden, Respiratory effort, Awake Endoscopic anatomy, and Sleep position dependency) system for OSA.
• To assess SNORES' ability to predict therapy escalation, CPAP adherence, and surgical intervention.
• To compare SNORES' predictive performance against the AHI alone.

Main Methods:

• A prospective, multicenter cohort study included 1560 adults with newly diagnosed OSA.
• The SNORES system, comprising six domains, was scored from 0 to 3 based on objective criteria.
• Primary outcomes included therapy escalation, CPAP adherence, and surgical intervention, with predictive performance compared to AHI.

Main Results:

• Higher SNORES scores were significantly associated with increased risk of therapy escalation (HR 3.10) and surgical intervention (HR 2.71).
• The SNORES framework showed superior discrimination for predicting therapy escalation (AUC 0.82) compared to AHI alone (AUC 0.52).
• Omitting specific SNORES domains, like oxygen desaturation or respiratory effort, reduced predictive accuracy.

Conclusions:

• The SNORES system is a feasible and reproducible multidimensional framework for classifying OSA.
• SNORES captures clinically relevant OSA heterogeneity, enabling more effective individualized therapy guidance.
• This system outperforms traditional AHI-only models in predicting treatment pathways and outcomes.