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Comparative Study
. 2025 Jan 29;25(1):46.
doi: 10.1186/s12871-025-02926-1.

Comparison of NoSAS score with STOP-Bang and Berlin scores in predicting difficult airway

Onurcan Balık  1 , Eyyüp Sabri Özden  2 , Mustafa Soner Özcan  1 , Filiz Alkaya Solmaz  1 , Pakize Kırdemir  1
Affiliations
Comparative Study

Comparison of NoSAS score with STOP-Bang and Berlin scores in predicting difficult airway

Onurcan Balık et al. BMC Anesthesiol. .

Abstract

Background: This study aimed to compare the effectiveness of the NoSAS, STOP-Bang, and Berlin scoring systems, which are utilized to predict obstructive sleep apnea syndrome (OSAS), in forecasting difficult airway management. Additionally, the study sought to determine which of these scoring systems is the most practical and effective for this purpose.

Methods: Following the ethics committee approval, preoperative NoSAS, STOP-Bang, and Berlin scores were calculated for 420 patients aged 18 years and older who were scheduled for tracheal intubation. Mask ventilation and intubation were performed by research assistant with a minimum of two years of experience. Detailed examinations and recordings were conducted, including demographic data, neck circumference, OSAS diagnosis, history of difficult intubation, comorbidities, ASA classification, Mallampati classification, and Cormack-Lehane grade. Subsequently, the predictive efficacy of these three scoring systems for difficult mask ventilation and difficult intubation was compared.

Results: In our study, 83 patients (19.8%) were classified as having difficult mask ventilation, and 101 patients (24.0%) were classified as having difficult intubation. The NoSAS score demonstrated a higher predictive power compared to the other scoring systems for difficult mask ventilation and difficult intubation. The cut-off value for the NoSAS score was determined to be 6.5 for predicting difficult mask ventilation and 7.5 for predicting difficult intubation.

Conclusion: The routine implementation of the NoSAS score, an easy-to-use, rapid and objective tool primarily developed for OSAS screening, is likely to be effective in preoperatively identifying difficult airways in patients undergoing general anesthesia.

Keywords: Berlin score; Difficult airway; NoSAS score; STOP-Bang score.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Süleyman Demirel University Clinical Research Ethics Committee (decision number 41, dated March 6, 2023). An informed consent to participate was obtained from all of the participants in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ROC curve comparing the effectiveness of NoSAS, STOP-Bang, and Berlin scoring systems in predicting difficult mask ventilation
Fig. 2
Fig. 2
ROC curve comparing the effectiveness of NoSAS, STOP-Bang, and Berlin scoring systems in predicting difficult intubation
See this image and copyright information in PMC

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