Comparison of NoSAS score with Berlin and STOP-BANG scores for sleep apnea detection in a clinical sample

Validation of NoSAS score for the screening of obstructive sleep apnea

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder (SBD) characterized by the repetitive collapse of the upper airway during sleep. The aim of the present study was to validate the Neck circumference, Obesity, Snoring, Age, Sex (NoSAS) score in a sample population and to compare its validity for OSA screening, with that of the Berlin questionnaire, STOP-BANG questionnaire and Epworth Sleepiness Scale (ESS). A retrospective analysis was conducted on individuals, aged 18 to 80 years, who reported symptoms indicating SBD and were examined with full-night polysomnography (PSG) at a sleep center. Demographics, anthropometric parameters, comorbidities, ESS, STOP-BANG questionnaire, Berlin questionnaire and PSG data were obtained from the recorded data of the patients. The NoSAS score was determined using the recorded data. A total of 347 participants were enrolled in the study. The NoSAS scores identified individuals with OSA, with an area under the curve (AUC) of 0.774. The NoSAS score performed significantly better than the Berlin questionnaire (AUC 0.617) and the ESS (AUC 0.642), and similarly to STOP-BANG (AUC 0.777) for OSA screening. Using a NoSAS score >7 to predict OSA, the sensitivity and specificity were 85.6 and 50%, respectively; using the STOP-BANG questionnaire, for a score >2, the values were 98.32 and 22% respectively; using the Berlin questionnaire for >1 positive categories, the values were 93.6 and 20%, and using the ESS, for a score >10, the values were 30.3% and 72%, respectively. On the whole, the present study demonstrates that the NoSAS score is a simple, efficient and easy method for screening OSA in the clinical setting. The NoSAS score performs significantly more efficiently than the Berlin questionnaire and ESS, and similarly to STOP-BANG questionnaire for OSA screening.

Validation of GOAL questionnaire as screening tool for clinical obstructive sleep apnea: A large sample study in China

Background

Obstructive sleep apnea (OSA) is a serious disease with a high prevalence in the general population. The purpose of this study is to explore the effectiveness of the GOAL questionnaire in the clinical screening of OSA and compare it with other existing screening tools.

Materials and methods

Outpatients and inpatients who underwent polysomnography (PSG) examination at the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from January 2013 to November 2016 were analyzed retrospectively. The basic data such as demographic, medical history, etc., and PSG data of the patients were collected, and the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of GOAL and five other screening scales (the NoSAS score, Epworth Sleepiness Scale, the Berlin questionnaire, STOP, and STOP-Bang questionnaire) were calculated.

Results

Data from 2,171 participants (1,644 male; 78%) were analyzed there were 1,507 OSA patients [Apnea Hypopnea Index (AHI) ≥ 5 events/h] among them, accounting for about 69.415%. No matter which cut-off point (AHI ≥ 5, 15 and 30 events/h), the AUC score reveals that GOAL questionnaire had comparable screening ability to the NoSAS and STOP-BANG, and performed better than the ESS, and the AUC scores of the STOP questionnaire and Epworth Sleepiness Scale (ESS) were both lower than 0.7. When the cut-off point of the AHI was 5 events/h, the AUC of GOAL was the highest at 0.799 (0.781–0.816), and its sensitivity was the highest at 89.1%. The sensitivity levels of the NoSAS score and STOP-Bang questionnaire were 67.4 and 78.8% respectively, while ESS and the Berlin questionnaire have higher specificity (70.2 and 72.3% respectively) but lower sensitivity (49.3 and 60.0% respectively).

Conclusion

GOAL is a free, efficient and easy to manage tool with a screening ability comparable to NoSAS and STOP-Bang, and better than that of ESS.

Incorporating neck circumference or neck-to-height ratio into the GOAL questionnaire to better detect and describe obstructive sleep apnea with application to clinical decisions

Objective

Although neck circumference (NC) and neck-to-height ratio (NHR) have been recognized as effective predictors of the clinical diagnosis of adult obstructive sleep apnea (OSA), they have not been included in the widely used GOAL questionnaire. Not coincidentally, the NHR has not been adequately considered in the development and validation of the STOP-Bang questionnaire, No-Apnea score and the NoSAS score. The motivation for the study was (1) to combine the GOAL questionnaire with the NC and NHR, respectively, to evaluate its predictive performance and (2) to compare it with the STOP-Bang questionnaire, the No-Apnea score, the NOSAS score, and the GOAL questionnaire.

Materials and methods

This retrospectively allocated cross-sectional study was conducted from November 2017 to March 2022 in adults who underwent nocturnal polysomnography (PSG) or home sleep apnea testing (HSAT). In this paper, the GOAL questionnaire was combined with the NC and NHR, respectively, using logistic regression. The performance of the six screening tools was assessed by discriminatory ability [area under the curve (AUC) obtained from receiver operating characteristic (ROC) curves] and a 2 × 2 league table [including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR−)] and compared under AHI ≥5/h, AHI ≥15/h, and AHI ≥30/h conditions.

Results

A total of 288 patients were enrolled in the study. For all severity OSA levels, the sensitivity of GOAL+NC ranged from 70.12 to 70.80%, and specificity ranged from 86.49 to 76.16%. The sensitivity of GOAL+NHR ranged from 73.31 to 81.75%, while specificity ranged from 83.78 to 70.86%. As for area under the curve (AUC) value under ROC curve, when AHI ≥5/h, compared with GOAL (0.806), No-Apnea (0.823), NoSAS (0.817), and GOAL+NC (0.815), GOAL+NHR (0.831) obtained the highest AUC value, but lower than STOP-Bang (0.837).

Conclusion

The predictive power of incorporating NC or NHR into the GOAL questionnaire was significantly better than that of the GOAL itself. Furthermore, GOAL+NHR was superior to GOAL+NC in predicting OSA severity and better than the No-Apnea score and the NoSAS score.

Defining obstructive sleep apnoea syndrome: a failure of semantic rules

Obstructive sleep apnoea syndrome (OSAS) is one of the most ubiquitous medical conditions in industrialised society. Since the recognition that symptoms of excessive daytime somnolence, problems with concentration, mood and cognitive impairment, as well as cardiometabolic abnormalities can arise as a consequence of obstructed breathing during sleep, it has been subject to variation in its definition. Over the past five decades, attempts have been made to standardise the definitions and scoring criteria used for apnoeas and hypopnoea, which are the hallmarks of obstructive sleep apnoea (OSA). However, applying these definitions in clinical and research practice has resulted in over- and under-estimation of the severity and prevalence of OSAS. Furthermore, the definitions may eventually become redundant in the context of rapid technological advances in breathing measurement and other signal acquisition. Increased efforts towards precision medicine have led to a focus on the pathophysiology of obstructed breathing during sleep. However, the same degree of effort has not been focused on how and why the latter does or does not result in diurnal symptoms, integral to the definition of OSAS. This review focuses on OSAS in adults and discusses some of the difficulties with current definitions and the possible reasons behind them.

The definition of obstructive sleep apnoea syndrome appears to be in constant flux dependent on the definitions attributed to its diagnostic componentshttps://bit.ly/3zXrWKg

Risk of obstructive sleep apnea among taxi-motorbike drivers in Parakou city in West Africa and associated factors with road traffic accidents

OBJECTIVES

Obstructive sleep apnea (OSA) is an underdiagnosed chronic respiratory disease, causing excessive daytime sleepiness (EDS) and road traffic accidents (RTA). This study aimed to determine the risk of OSA among taxi-motorbike drivers (TMD) and factors associated with RTA in Parakou, Benin.

METHODS

A cross-sectional comparative study was carried out between July and September 2020, including 225 TMD and 450 motorbike drivers other than TMD (non-TMD). A multiple logistic regression was then performed to determine factors associated with RTA.

RESULTS

The mean age of participants was 38.2 ± 10.2 and 36.6 ±10.9 years, respectively, for TMD and non-TMD (p = .048). The average daily working time was 10.7 ± 2.3H and 9.1±3.5H, respectively, for TMD and non-TMD (p < .001). Average sleeping time was comparable in both groups (7.5±1.4H vs 7.4±1.4H; p = .415). TMD significantly more complained of non-restorative sleep (38.7% vs 18.4%; p < .001) but less of EDS (20.0% vs 28.7%; p = .015). Abdominal obesity predominated in TMD (13.8% vs 4.4%; p < .001). An increased risk of OSA (NoSAS score ≥8) was diagnosed in 25.8% TMD and 26.7% non-TMD (p = .805). Overall, 25.8% of TMD and 18.4% of non-TMD (p = .027) reported at least one RTA in the last 12 months. After adjusted analysis, the unique factor associated with RTA was a daily sleeping pills consumption (aOR=2.2; 95%CI = 1.2-3.8; p = .006).

CONCLUSION

There is need to improve systematic screening and diagnosis of OSA in both TMD and non-TMD and reinforce the regulation and consumption of sleeping pills.

Diagnostic accuracy of the Berlin questionnaire and the NoSAS score in detecting risk for obstructive sleep apnea in rotating shift workers

BACKGROUND

Data on the validity of tools for sleep apnea risk detection in rotating shift workers are limited. The aim was to evaluate the Berlin questionnaire (BQ) and the Neck, Obesity, Snoring, Age, Sex (NoSAS) score for the detection of obstructive sleep apnea risk in shift workers.

METHODS

This cross-sectional study included male rotating shift workers, drivers of heavy off-road machinery in an iron ore extraction company. Polysomnography was the gold standard for evaluation. Obstructive sleep apnea (OSA) was defined as an apnea-hypopnea index (AHI) of ≥ 5 events/h. The Shapiro-Wilk test verified the data distribution and comparative analysis was conducted using the chi-square analyses and U Mann-Whitney with Bonferroni correction. Receiver operating characteristic curve analysis, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and accuracy were used for evaluate BQ and NoSAS with OSA diagnosis by polysomnograph.

RESULTS

Among 119 male shift workers, ages 24 to 57 years, polysomnography showed that 84% had obstructive sleep apnea (AHI ≥ 5), and 46% had moderate to severe sleep apnea (AHI ≥ 15). For AHI ≥ 5, the NoSAS score had higher sensitivity and specificity than the BQ. For AHI ≥ 15 and AHI ≥ 30, the NoSAS score had a sensitivity higher than 70% while BQ was 60% and 58%, respectively. The accuracy of the NoSAS score was higher for all OSA criteria than that of BQ.

CONCLUSION

In rotating shift workers, drivers of heavy off-road machinery, the NoSAS score showed higher accuracy in identifying patients at risk for sleep apnea than the BQ.

Multitargeting the sleep-pain interaction with pharmacological approaches: A narrative review with suggestions on new avenues of investigation

The multimorbidity formed by sleep disturbances and pain conditions is highly prevalent and has a significant impact in global health and in the socioeconomic system. Although different approaches have been directed toward its management, evidence regarding an optimal treatment is lacking, and pharmacological options are often preferred. Health professionals (e.g., pain and sleep clinicians) tend to focus on their respective expertise, targeting a single symptom with a single drug. This may increase polypharmacy and the risk of drug interactions, adverse events, and mortality. Hence, the use of medications that can directly or indirectly improve sleep, pain, and other possible accompanying conditions without exacerbating them becomes especially relevant. The objectives of this comprehensive review are to: a) describe the beneficial or deleterious effects that some commonly used medications to manage pain have on sleep and sleep disorders; and b) describe the beneficial or deleterious effects that frequently prescribed medications for sleep may have on pain. Moreover, medications targeting some specific sleep-pain interactions will be suggested and future directions for improving sleep and alleviating pain of these patients will be provided with clinical and research perspectives.