Diagnostic Value of Airway Ultrasound for Obstructive Sleep Apnea-Hypopnea Syndrome and Its Incremental Value Over the Neck circumference, Obesity, Snoring, Age, Sex score: A Case-Control Study

This study aimed to evaluate the diagnostic performance of airway ultrasound parameters for obstructive sleep apnea-hypopnea syndrome (OSAHS) and to determine their incremental value beyond the Neck circumference, Obesity, Snoring, Age, Sex score (NoSAS) score.

In this case-control study, 47 participants with OSAHS and 30 controls underwent overnight polysomnography (PSG) with calculation of the apnea-hypopnea index (AHI) and NoSAS scoring. Airway ultrasound assessed tongue-base thickness (TBT), hyoid-bone depth (HBD), epiglottis depth (ED), and geniohyoid shear-wave velocity (SWV). Multivariable logistic regression and receiver operating characteristic (ROC) analyses were used to quantify discrimination and compare models.

Compared with controls, participants with OSAHS had higher TBT, HBD, and ED and lower SWV. In the primary multivariable model, TBT, SWV, and the NoSAS score were associated with OSAHS. After adjustment for BMI and neck circumference, TBT remained independently associated with OSAHS, whereas the associations of SWV and the NoSAS score were attenuated. TBT provided the highest single-parameter accuracy (AUC 0.896). The NoSAS score alone showed comparable discrimination (AUC 0.895), whereas the combined model showed significantly improved discrimination (AUC 0.951; DeLong p = 0.038 versus NoSAS alone).

Airway ultrasound offers clinically relevant, non-invasive discrimination for OSAHS, with TBT showing the best individual performance; integrating ultrasound with NoSAS may improve screening and triage for PSG.