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Patient-Performed Neck Encirclement Within the NoSAS Score: Score Availability and Diagnostic Performance in a
Sarah Kassir1, Claudio Rabec2, Raphael Heinzer3
1Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils De Lyon, Lyon, France.
Background:
Obstructive sleep apnea (OSA) is highly prevalent, and early identification remains a major public health challenge. The NoSAS score is a simple and validated screening tool, incorporating neck circumference >40 cm. However, neck circumference measurement may be inconsistently performed in routine practice. Patient-performed neck encirclement, an equipment-free hand-based maneuver, may represent a pragmatic alternative.
Methods:
We conducted a retrospective analysis of prospectively collected routine clinical data including 449 consecutive patients referred for suspected OSA in a tertiary sleep center (Lyon, France) between September and December 2025. Neck circumference and Patient-performed manual neck encirclement were assessed at the same anatomical level. Diagnostic performance was evaluated for apnea-hypopnea index (AHI) thresholds ≥15 and ≥30 events·h-1. A modified NoSAS score incorporating patient-performed neck encirclement (NoSAS hand) was compared with the standard score. In paired complete-case comparisons, diagnostic estimates and between-score differences were reported with 95% confidence intervals and McNemar tests.
Results:
Patient-performed neck encirclement was substantially more available than measured neck circumference (94.0% vs 71.3%) and NoSAS hand was calculable more often than standard NoSAS (91.3% vs 68.8%). In the paired complete-case cohort (n=305), at AHI ≥15/h, sensitivity and specificity differences (NoSAS hand minus standard NoSAS) were 0.0% (95% CI -1.9 to 1.9) and +1.0% (95% CI -2.0 to 5.1), respectively; corresponding differences at AHI ≥30/h were 0.0% (95% CI -2.5 to 2.5) and +0.5% (95% CI -1.6 to 2.7).
Conclusions:
Patient-performed neck encirclement is a simple, equipment-free alternative to measured neck circumference that substantially improves the feasibility of NoSAS implementation while preserving diagnostic performance. In this tertiary sleep-centre workflow, patient-performed neck encirclement was recorded more often than measured neck circumference and increased NoSAS score availability; paired point estimates of sensitivity and specificity at AHI ≥15/h and ≥30/h differed little between scores.
