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Validation of NoSAS score for screening of sleep-disordered breathing in a multiethnic Asian population

  • Epidemiology • Original Article
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Abstract

Purpose

The NoSAS score was developed to identify subjects at high risk of sleep-disordered breathing (SDB). We aimed to validate the NoSAS score in a multiethnic Asian cohort and compare its performance to the STOP-Bang and Berlin questionnaires.

Methods

A sample of 242 subjects selected from a population-based cohort in Singapore completed home-based sleep testing with an Embletta device (type 3 monitor). All subjects were given the STOP-Bang and Berlin questionnaires for self-administration prior to the sleep study. The NoSAS score was subsequently calculated based on available demographic data and Berlin questionnaire responses.

Results

The prevalence of severe SDB, defined as an apnea-hypopnea index cutoff of ≥30 events/h, was 10.7%. The number of subjects who were classified as high risk by the NoSAS score and STOP-Bang and Berlin questionnaires were 76 (31.4%), 89 (36.8%), and 79 (32.6%), respectively. The sensitivity, specificity, and negative and positive predictive values of the NoSAS score to predict severe SDB were 69.2, 73.1, 95.2, and 23.7%, respectively. The STOP-Bang and Berlin questionnaires performed similarly to the NoSAS score, with area under the curve (AUC) values of all three questionnaires clustered around 0.682–0.748. Compared to the STOP-Bang (94.8%) and Berlin questionnaires (96.3%), the NoSAS score (95.2%) had equally high negative predictive value in ruling out severe SDB.

Conclusions

The NoSAS score performed similarly to the STOP-Bang and Berlin questionnaires in a multiethnic Asian cohort. All three questionnaires had high negative predictive values in ruling out severe SDB and may have utility as screening tools.

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Abbreviations

SDB:

Sleep-disordered breathing

AHI:

Apnea-hypopnea index

AASM,:

American Academy of Sleep Medicine

PSG:

Polysomnography

BMI:

Body mass index

NPV:

Negative predictive value

PPV:

Positive predictive value

AUC:

Area under the curve

PSQI:

Pittsburg Sleep Quality Index

SpO2 :

Oxygen saturation as measured by pulse oximetry.

References

  1. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. The Lancet Respiratory medicine 3(4):310–318. doi:10.1016/s2213-2600(15)00043-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177(9):1006–1014. doi:10.1093/aje/kws342

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chen X, Wang R, Zee P, Lutsey PL, Javaheri S, Alcantara C, Jackson CL, Williams MA, Redline S (2015) Racial/ethnic differences in sleep disturbances: the multi-ethnic study of atherosclerosis (MESA). Sleep 38(6):877–888. doi:10.5665/sleep.4732

    PubMed  PubMed Central  Google Scholar 

  4. Redline S, Sotres-Alvarez D, Loredo J, Hall M, Patel SR, Ramos A, Shah N, Ries A, Arens R, Barnhart J, Youngblood M, Zee P, Daviglus ML (2014) Sleep-disordered breathing in Hispanic/Latino individuals of diverse backgrounds. The Hispanic community health study/study of Latinos. Am J Respir Crit Care Med 189(3):335–344. doi:10.1164/rccm.201309-1735OC

    Article  PubMed  PubMed Central  Google Scholar 

  5. Watson NF (2016) Health care savings: the economic value of diagnostic and therapeutic care for obstructive sleep apnea. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 12(8):1075–1077. doi:10.5664/jcsm.6034

    Google Scholar 

  6. Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J (2004) Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med 169(6):668–672. doi:10.1164/rccm.200308-1124PP

    Article  PubMed  Google Scholar 

  7. Qaseem A, Dallas P, Owens DK, Starkey M, Holty JE, Shekelle P (2014) Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med 161(3):210–220. doi:10.7326/m12-3187

    Article  PubMed  Google Scholar 

  8. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108(5):812–821. doi:10.1097/ALN.0b013e31816d83e4

    Article  PubMed  Google Scholar 

  9. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491

    Article  CAS  PubMed  Google Scholar 

  10. Marti-Soler H, Hirotsu C, Marques-Vidal P, Vollenweider P, Waeber G, Preisig M, Tafti M, Tufik SB, Bittencourt L, Tufik S, Haba-Rubio J, Heinzer R (2016) The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. The Lancet Respiratory medicine. doi:10.1016/s2213-2600(16)30075-3

    Google Scholar 

  11. Tan A, Cheung YY, Yin J, Lim WY, Tan LW, Lee CH (2016) Prevalence of sleep-disordered breathing in a multiethnic Asian population in Singapore: a community-based study. Respirology (Carlton, Vic) 21(5):943–950. doi:10.1111/resp.12747

    Article  Google Scholar 

  12. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 8(5):597–619. doi:10.5664/jcsm.2172

    Google Scholar 

  13. Lee RW, Vasudavan S, Hui DS, Prvan T, Petocz P, Darendeliler MA, Cistulli PA (2010) Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. Sleep 33(8):1075–1080

    Article  PubMed  PubMed Central  Google Scholar 

  14. Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C (2000) Obstructive sleep apnea syndrome: a comparison between far-east Asian and white men. Laryngoscope 110(10 Pt 1):1689–1693. doi:10.1097/00005537-200010000-00022

    Article  CAS  PubMed  Google Scholar 

  15. Arnardottir ES, Bjornsdottir E, Olafsdottir KA, Benediktsdottir B, Gislason T (2016) Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms. The European respiratory journal 47(1):194–202. doi:10.1183/13993003.01148-2015

    Article  PubMed  Google Scholar 

  16. Bixler EO, Vgontzas AN, Gaines J, Fernandez-Mendoza J, Calhoun SL, Liao D (2016) Moderate sleep apnoea: a "silent" disorder, or not a disorder at all? The European respiratory journal 47(1):23–26. doi:10.1183/13993003.01955-2015

    Article  PubMed  Google Scholar 

  17. Vat S, Haba-Rubio J, Tafti M, Tobback N, Andries D, Heinzer R (2015) Scoring criteria for portable monitor recordings: a comparison of four hypopnoea definitions in a population-based cohort. Thorax 70(11):1047–1053. doi:10.1136/thoraxjnl-2014-205982

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank the staff of Easmed Private Limited, for their assistance with the home-based sleep studies; Venesa Loh and Tan Ching Yee with the patient recruitment; and Glenn Rolden (RGPST) and Hafiz Firdaus Bin Abdul Haddy for the analysis of the sleep tracings.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Jurong Health Services, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore

    Adeline Tan

  2. Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore

    Yueheng Hong, Linda W.L. Tan & Rob M. van Dam

  3. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore

    Rob M. van Dam, Yan Yi Cheung & Chi-Hang Lee

  4. Department of Cardiology, National University Heart Centre, Singapore, Singapore

    Yan Yi Cheung & Chi-Hang Lee

Authors
  1. Adeline Tan
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  2. Yueheng Hong
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  3. Linda W.L. Tan
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  4. Rob M. van Dam
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  5. Yan Yi Cheung
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  6. Chi-Hang Lee
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Corresponding author

Correspondence to Adeline Tan.

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Funding

This study was funded by the FY2014 Health Services Research and Quality Improvement Grant of Ng Teng Fong General Hospital, Jurong Health Services.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by the ethics committee of the participating hospital and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Tan, A., Hong, Y., Tan, L.W. et al. Validation of NoSAS score for screening of sleep-disordered breathing in a multiethnic Asian population. Sleep Breath 21, 1033–1038 (2017). https://doi.org/10.1007/s11325-016-1455-4

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  • DOI: https://doi.org/10.1007/s11325-016-1455-4

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