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Effects of age and sex on the performance of the NoSAS score as a screening tool for obstructive sleep apnea: a hospital-based retrospective study in China

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Objectives

The NoSAS score has been shown to be a reliable screening tool for obstructive sleep apnea (OSA) in overall populations. This study aimed to explore the effects of age and sex on the predicting performance of this score.

Methods

A retrospective analysis was conducted on 1119 subjects aged ≥ 18 years and with a total sleep time of ≥ 4 h during overnight polysomnography. Discrimination was assessed by using areas under receiver operating characteristic curve (AUCs), while predictive parameters were calculated by using contingency tables.

Results

Overall, a NoSAS score of 8 points or higher resulted in sensitivity, specificity, and AUC for predicting an apnea−hypopnea index (AHI) of ≥ 20 events/h of 74%, 36%, and 0.63 (in non-elderly 73%, 46%, and 0.65; in elderly 91%, 17%, and 0.59; in men 85%, 18%, and 0.56; in women 52%, 76%, and 0.71, respectively). The AUCs at all AHI cutoffs were significantly lower in men than in women (all with p < 0.01), while the AUCs at AHI cutoff of 5, 15, and 30 events/h were significantly lower in elderly than in non-elderly (p < 0.01, 0.05, and 0.05, respectively). In non-elderly, a conventional NoSAS with cutoff of 7 or a modified NoSAS with age cutoff of 50 years provided sensitivity and specificity for predicting an AHI of ≥ 20 events/h of 87%, 37% and 80%, 36%, respectively, with comparable AUCs. In women, a conventional NoSAS with cutoff of 6 or a modified NoSAS with neck circumference cutoff of 35 cm provided sensitivity and specificity for predicting an AHI of ≥ 20 events/h of 85%, 39% and 79%, 52%, respectively, with comparable AUCs.

Conclusions

NoSAS score has better discrimination but lower sensitivity for predicting OSA in non-elderly and women than in their counterparts. Age- and sex-specific cutoff values reverse this imbalance. Our results underline the preference of age- and sex-specific cutoff values and the need for better age- and sex-specific screening algorithms.

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Authors and Affiliations

  1. Department of Geriatrics, Peking University First Hospital, Beijing, 100034, China

    Zhigang Zhang, Dan Yang, Haiying Wang & Xinmin Liu

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  1. Zhigang Zhang
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  2. Dan Yang
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  3. Haiying Wang
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  4. Xinmin Liu
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Zhigang Zhang, Dan Yang, and Haiying Wang. The first draft of the manuscript was written by Zhigang Zhang. The draft was reviewed and edited by Zhigang Zhang and Xinmin Liu. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Zhigang Zhang.

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The authors declare that they have no conflict of interest.

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This study protocol was approved by the Ethics Committee of Peking University First Hospital and waived the patient consent requirement.

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Zhang, Z., Yang, D., Wang, H. et al. Effects of age and sex on the performance of the NoSAS score as a screening tool for obstructive sleep apnea: a hospital-based retrospective study in China. Sleep Breath 25, 1407–1417 (2021). https://doi.org/10.1007/s11325-020-02254-3

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  • DOI: https://doi.org/10.1007/s11325-020-02254-3

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