IDENTIFYING SUBJECTS AT RISK FOR OBSTRUCTIVE SLEEP APNEA: A COMPARISON OF SCREENING METHODS

Abstract

Obstructive sleep apnea (OSA) is a common but often underdiagnosed condition that negatively affects quality of life and increases the risk of developing cardiovascular diseases and risk of traffic accidents. Early diagnosis and management are essential for reducing complications. A full-night polysomnography (PSG) is the gold standard for detecting OSA, however, its accessibility is limited due to the complexity of the procedure. Screening questionnaires and scales are particularly useful for identifying individuals at the highest risk for OSA who require further testing. The diagnostic value of the NoSAS scale and STOP BANG questionnaire in OSA diagnosis is widely discussed worldwide. Daytime sleepiness is one of the most common symptoms of OSA. The Epworth Sleepiness Scale (ESS) is also used as one of the screening criteria for PSG, therefore, its diagnostic value for OSA was also assessed. Aim of the study. To determine the diagnostic value of different screening methods for sleep testing – STOP-BANG questionnaire and the NoSAS scale, compare their results with the ESS scale. Methods. Analysis of patients evaluated at the Lithuanian University of Health Sciences Department of Pulmonology due to suspected sleep-related breathing disorders was performed. OSA was diagnosed when the PSG apnea–hypopnea index (AHI) was >5 events/hour. The STOP-BANG questionnaire (snoring, tiredness, observed apneas, high blood pressure, BMI, age, neck circumference, gender) and NoSAS scale (neck circumference, obesity, snoring, age, gender) were compared using ROC curve analysis. ESS results were also analysed. STOP BANG and ESS results collected prospectively in 2018 were used, while NoSAS scores were assessed retrospectively from medical records. The findings were compared to 2023 data. Results. The study comprised 589 patients (69,4% men, 30,6% women). The mean age of participants was 54,29 ± 12,42 years. Mild OSA was diagnosed in 20,5%, moderate OSA in 22,4%, and severe OSA in 46,9% of patients. In 10,2% of cases, OSA was ruled out. The highest sensitivity and specificity were observed with a STOP-BANG score ≥5 and a NoSAS score ≥10 (AUC = 0,789, 0,769, and 0,842, respectively). The optimal cutoff value for the ESS was ≥8, with a sensitivity of 52,7% and specificity of 52,4%. The ESS did not demonstrate reliable prognostic properties. Conclusions. The 2018 and 2023 STOP-BANG questionnaire and NoSAS scale demonstrated high sensitivity and specificity in diagnosing OSA. The ESS should be used only as a method for assessing sleepiness, not as a primary screening tool for OSA diagnosis.