Prediction of obstructive sleep apnea: comparative performance of three screening instruments on the apnea-hypopnea index and the oxygen desaturation index

Abstract

Purpose: To evaluate the performance of the NoSAS (neck, obesity, snoring, age, sex) score, the STOP-Bang (snoring, tiredness, observed apneas, blood pressure, body mass index, age, neck circumference, gender) questionnaire, and the Epworth sleepiness score (ESS) as a screening tool for obstructive sleep apnea (OSA) severity based on the apnea-hypopnea index (AHI) and the oxygen desaturation index (ODI).

Methods: Data from 235 patients who were monitored by ambulant polysomnography (PSG) were retrospectively analyzed. OSA severity was classified based on the AHI; similar classification categories were made based on the ODI. Discrimination was assessed by the area under the curve (AUC), while predictive parameters were calculated by four-grid contingency tables.

Results: The NoSAS score and the STOP-Bang questionnaire were both equally adequate screening tools for the AHI and the ODI with AUC ranging from 0.695 to 0.767 and 0.684 to 0.767, respectively. Both questionnaires perform better when used as a continuous variable. The ESS did not show adequate discrimination for screening for OSA (AUC ranging from 0.450 to 0.525). Male gender, age, and BMI proved to be the strongest individual predictors in this cohort.

Conclusion: This is the first study to evaluate the predictive performance of three different screening instruments with respect to both the AHI and the ODI. This is important, due to increasing evidence that the ODI may have a higher reproducibility in the clinical setting. The NoSAS score and the STOP-Bang questionnaire proved to be equally adequate to predict OSA severity based on both the AHI and the ODI.

Keywords: ESS; NoSAS score; Obstructive sleep apnea; Polysomnography; STOP-Bang questionnaire; Screening.

Fig. 1

Discriminatory ability reported as area under the curve (AUC) (95% CI). The NoSAS score, the STOP-Bang questionnaire, and the ESS are presented as continuous variables. OSA severity is classified based on AHI ≥ 5 (any OSA), AHI ≥ 15 (moderate to severe OSA), and AHI ≥ 30 (severe OSA). The ODI ≥ 3% is subdivided into ODI ≥ 5, ODI ≥ 15, and ODI ≥ 30. The NoSAS score performed similar when compared with the STOP-Bang questionnaire on all cutoff points (all comparisons with p value > 0.05). The ESS presented lower discrimination than presented by the NoSAS score and the STOP-Bang questionnaire on all cutoff points (all comparisons with p value < 0.05)

Fig. 2

Discriminatory ability reported as area under the curve (AUC) (95% CI). The NoSAS score and the STOP-Bang questionnaire are presented as continuous variables. The green ROC curve shows the plotted predicted probability of gender, age, and BMI. The predicted probability performs similar to the NoSAS score and the STOP-Bang questionnaire (all comparisons with p value > 0.05). The ROC curves are presented at AHI ≥ 15 and ODI ≥ 15