STOP-Bang and NoSAS questionnaires as a screening tool for OSA: which one is the best choice?

Abstract

SUMMARY INTRODUCTION: Currently there has been significant growth in the number of patients with suspected obstructive sleep apnea (OSA) referred to sleep clinics. In this sense, screening and stratification methods of the severity of this pathology have become increasingly relevant. OBJECTIVE: To evaluate the performance of the NoSAS and STOP-Bang scores in the screening of OSA in a sleep clinic. METHODS: Prospectively, for 12 months, all patients referred by primary care physicians to our sleep unit for clinical evaluation and who underwent in-lab polysomnography (PSG), also completed the NoSAS score (Neck circumference, Obesity, Snoring, Age, Sex) and STOP-Bang (Snoring, Tiredness, Observed apnea, Pressure (high blood), BMI, Age, Neck circumference, Gender). A ROC (receiver operating characteristic) analysis was used to find the scores that simultaneously maximize sensitivity and specificity for each diagnosis. RESULTS: Of the 294 individuals included, 84% had OSA, of which 28.8% were mild, 34.8% moderate, and 36.4% were severe. USING THE NOSAS SCORE FOR PREDICTING OSA, MODERATE TO SEVERE OSA, AND SEVERE OSA, THE ROC AREA WAS: 0.770 (95% CI: 0.703-0.837), p<0.001, sensitivity of 57.5%, and specificity of 83.0% for a score of 12; 0.746 (95% CI: 0.691-0.802), p<0.001, sensitivity of 68.2% and specificity of 75.4% for a score of 13; 0.686 (95% CI: 0.622-0.749), p<0.001, sensitivity of 71.1% and specificity of 58.3% for a score of 13, respectively. USING THE STOP-BANG SCORE FOR PREDICTING OSA, MODERATE TO SEVERE OSA, AND SEVERE OSA, THE ROC AREA WAS: 0.862 (95% CI: 0.808-0.916), p<0.001, sensitivity of 68.4% and specificity of 85.1% for a score of 5; 0.813 (95% CI: 0.756-0.861), p<0.001, sensitivity of 77.3% and specificity of 66.1% for a score of 5; 0.787 (95% CI: 0.732-0.841), p<0.001, sensitivity of 70.0% and specificity of 79.9% for a score of 6, respectively. CONCLUSIONS: The ROC area was consistently high for both scores confirming the diagnostic ability of the NoSAS and STOP-Bang questionnaires for all OSA severities. Thus, our results suggest that these questionnaires may be a powerful tool for the screening and stratification of patients in the diagnosis of OSA. Overall, the diagnostic ability of the STOP-Bang was higher than the NoSAS.

Comparison of six assessment tools to screen for obstructive sleep apnea in patients with hypertension

“…The proportion of males was much higher than that of females, which is consistent with the results of previous epidemiological studies. 3,14 It has been reported in the literature that the patient's neck circumference, waist circumference and BMI value affect the severity of OSA, 15 which is also consistent with our research results. However, our research shows that the differences between OSA and smoking, drinking and age were not statistically significant.…”

“…Some studies have found that the areas under the curve of STOP-Bang and NoSAS's ROCs were always very high, making them powerful tools for the screening and stratification of OSA patients, but the diagnostic ability of STOP-Bang is higher than that of NoSAS. 14 However, on the contrary, Rong et al 23 found that NoSAS has good predictive value for screening patients with sleep disorders, and its discrimination ability is higher than that of STOP-Bang. More studies have reported that NoSAS shows better discrimination ability than the ESS, Berlin and STOP-Bang screening tools, not only in moderate to severe sleep disordered breathing, but also in mild cases.…”

Development and assessment of a risk prediction model for moderate-to-severe obstructive sleep apnea

“…A Meta-analysis of NoSAS showed a combined sensitivity of 79.8%, a combined specificity of 58.2%, and the AUC was 0.77 (Chen et al, 2022). When evaluating moderate-to-severe OSA, the AUC was 0.746, the sensitivity was 68.2% and the specificity was 75.4% (Costa et al, 2020). Our predictive model still outperformed the NoSAS score compared to our model.…”

Development and validation of a simple clinical nomogram for predicting obstructive sleep apnea

“…It has been reported in the literature that the AUC of OSA at all levels of severity is always greater than 0.72 (Duarte et al, 2019), which is consistent with our research, but lower than the AUC of our nomogram. At present, several questionnaires including the BQ, STOP‐Bang, STOP and NoSAS have been developed clinically to determine high‐risk patients that should be given priority and, although these have brought great convenience to clinics, their efficiency in diagnosing OSA is still not satisfactory (Costa et al, 2020; Shi et al, 2020). However, the results of the nomograms of the previous four studies and the nomogram of our study show that they improve the discriminating ability of diagnosing OSA.…”

“…Obstructive sleep apnea (OSA) is the most common type of sleep breathing disorder. It is characterized by repeated partial or complete upper airway obstruction during sleep (Duarte et al, 2020), followed by a series of clinical symptoms such as daytime sleepiness, snoring, apnea and waking up (Costa et al, 2020). It is apparent that age, gender, body mass index (BMI), neck circumference (NC), waist circumference (WC), hypertension, coronary heart disease, craniofacial abnormalities and other risk factors are related to OSA (Yeghiazarians et al, 2021).…”