Establishment and Application Evaluation of an Improved Obstructive Sleep Apnea Screening Questionnaire for Chinese Community: The CNCQ-OSA

Objective

Obstructive sleep apnea (OSA) is a common sleep-disordered breathing disease. We aimed to establish an improved screening questionnaire without physical examinations for OSA named the CNCQ-OSA (Chinese community questionnaire for OSA).

Methods

A total of 2585 participants who visited sleep medicine center and underwent overnight polysomnography were grouped into two independent cohorts: derivation (n = 2180) and validation (n = 405). The CNCQ-OSA was designed according to the baseline of patients in derivation cohort. We comprehensively analyzed the data to evaluate the predictive value of the CNCQ-OSA, compared to the GOAL questionnaire, STOP-Bang questionnaire (SBQ) and NoSAS questionnaire.

Results

The CNCQ-OSA included seven variables: loud snoring, BMI ≥ 25 kg/m², male gender, apnea, sleepiness, hypertension and age ≥30, with a total score ranging from 7 to 16.7 points (≥13.5 points indicating high risk of OSA, ≥14.5 points indicating extremely high risk). In the derivation and validation cohorts, the areas under the curve of the CNCQ-OSA were 0.761 and 0.767, respectively. In the validation cohort, the sensitivity and specificity of a CNCQ-OSA score ≥13.5 points for the apnea-hypopnea index (AHI) ≥5/h were 0.821 and 0.559, respectively (Youden index, 0.380), and the score ≥14.5 points were 0.494 and 0.887, respectively (Youden index, 0.375). The CNCQ-OSA had a better predictive value for AHI ≥ 5/h, AHI > 15/h and AHI > 30/h, with the highest Youden index, compared to the other questionnaires.

Conclusion

The CNCQ-OSA can effectively identify the risk of OSA, which is appropriate for self-screening at home without physical examinations.

The role of screening questionnaires in the assessment of risk and severity of obstructive sleep apnea - polysomnography versus polygraphy

Obstructive sleep apnea (OSA) is a disease of significant importance, which may lead to numerous severe clinical consequences. The gold standard in the diagnosis of this sleep-related breathing disorder (SRBD) is polysomnography (PSG). However, due to the need for high expertise of staff who perform this procedure, its complexity, and relatively low availability, some simpler substitutes have been developed; among them is polygraphy (PG), which is most widely used. Also, there is a variety of questionnaires suitable to assess the pre-test probability and severity of OSA. The most frequently used ones are the STOP-BANG questionnaire (SBQ), NoSAS questionnaire, and Berlin questionnaire (BQ). However, they have different sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) when being used in various populations. The aim of this study is to provide a concise and clinically-oriented review of the most frequently used questionnaires, with special attention to its strengths and limitations. Moreover, we discuss whether PSG or PG would be more preferred for confirming OSA diagnosis with the highest likelihood.

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

BACKGROUND

Because of their high costs and low availability, sleep recordings cannot be used as routine procedures for sleep apnea screening. Therefore, it is important to have a performant screening tool allowing to select patients at higher risk for sleep apnea who need further investigations. The goal of the study is to compare the performances of the three commonly used sleep disordered breathing (SDB) screening questionnaires in a clinical sample.

METHODS

Clinical data and sleep studies performed in consecutive adult patients referred to the Lausanne University sleep center for sleep recordings between November 2016 and February 2018 were analysed. Berlin, STOP-Bang and NoSAS screening scores were calculated and compared with the sleep studies' results.

RESULTS

NoSAS score showed a NPV of 0.88, a PPV of 0.43 and a correctly classified rate of 71% for an AHI >15/h. STOP-Bang score had a slightly higher negative predictive value (0.92) but a very low positive predictive value (0.30) and a poor correctly classified rate (47%). Berlin score showed globally poor results (NPV:0.85, PPV: 0.29 and a correctly classified rate: 56%). NoSAS score had the highest area under ROC curves (0.78) compared to STOP-bang (0.71) and Berlin (0.62). NoSAS score however yielded a slightly higher rate of false negative than STOP-Bang score. NoSAS false negatives were mainly female snorers with a low neck circumference.

CONCLUSION

NoSAS score showed a better discrimination capacity compared to Berlin and STOP Bang scores in an unselected clinical population referred to a sleep center.

Evaluating the performance of five scoring systems for prescreening obstructive sleep apnea-hypopnea syndrome

PURPOSE

A comparison of all scoring systems used for screening for obstructive sleep apnea-hypopnea syndrome (OSAHS) is lacking. The aim of this investigation was to evaluate the performance of five scoring systems for screening for OSAHS, as well as to validate the use of the NoSAS and SACS in the Chinese population.

METHODS

Data were retrospectively collected from hospital-based, manned, overnight sleep monitoring studies for 105 consecutive outpatients using a portable monitor (PM) device.

RESULTS

The 105 participants had an average age of 46 years and were mostly men (75%). STOP-Bang, SACS, and NoSAS scoring exhibited moderate predictive values at different AHI cutoffs (AUC 0.761-0.853, 0.722-0.854, and 0.724-0.771 respectively), followed by the STOP and Berlin questionnaire (AUC 0.680-0.781vs 0.624-0.724). Both STOP-Bang and SACS showed excellent sensitivity (89.5-100% vs 93.4-94.6%) and negative predictive value (68-100% vs 77.3-90.9%), while STOP-Bang, STOP, and SACS showed low negative likelihood ratios (- LR) (0-0.2).

CONCLUSIONS

Our study indicated that the STOP-Bang questionnaire and the SACS both show better predictive value than other scoring systems among the five screening tools for OSAHS. Both scoring systems are simple and easy to implement for screening for OSAHS in the community and in hospitals.