Abstract
Background
Diagnosis of obstructive sleep apnea requires polysomnography which has limited availability. We aimed to develop and validate a risk score in predicting clinically significant OSA among the Thai population.
Methods
We reviewed polysomnographic studies performed in adults diagnosed with OSA in King Chulalongkorn Memorial Hospital from 2017 to 2019. 1798 and 450 patients were randomly enrolled in development and validation cohorts, respectively. A risk score was developed using multiple factor analysis and logistic regression. The NH-OSA score was externally validated at the Bangkok Christian Hospital. We compared its performance to existing screening scores (STOP-BANG, Berlin Questionnaire, Epworth Sleepiness Scale (ESS), and NoSAS score).
Result
The NH-OSA score allocates 1 point for having neck circumference ≥ 13 inches (in women) or 15 inches (in men), 4 points for the presence of hypertension, 3 or 5 or 7 points for having a body mass index of 23–24.9, 25–30, ≥ 30 kg/m2, respectively, 9 points for the presence of moderate or severe snoring, and 5 points for age ≥ 40 years. With a cutoff value at 14 points, the sensitivity and specificity were 82.1% and 68.7%, respectively. The AUC was 0.75 (0.73–0.78). Both internal and external validation study revealed high AUC of 0.74 (0.68–0.80) and 0.75 (0.60–0.90), respectively. These were greater when compared to STOP-BANG, Berlin Questionnaire, ESS, and NoSAS score.
Conclusion
NH-OSA is a newly developed tool which has good performance in predicting clinically significant OSA with high validity among the Thai population. It could help screen patients at risk of OSA for further investigation.
Similar content being viewed by others
Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- Abbreviation:
-
Definition
- AASM:
-
American Academy of Sleep Medicine
- AHI:
-
Apnea-hypopnea index
- AUC:
-
Area under the curve
- BMI:
-
Body mass index
- EEG:
-
Electroencephalogram
- ESS:
-
Epworth Sleepiness Scale
- KCMH:
-
King Chulalongkorn Memorial Hospital
- NH-OSA:
-
NH-OSA score
- OSA:
-
Obstructive sleep apnea
- PSG:
-
Polysomnography
- RDI:
-
Respiratory disturbance index
- RERAs:
-
Respiratory effort-related arousals
- ROC curve:
-
A receiver operating characteristic curve
References
Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pépin JL, Peppard PE, Sinha S, Tufik S, Valentine K, Malhotra A (2019) Estimation of the global prevalence and burden of obstructive sleep apnea: a literature-based analysis. Lancet Respir Med 7:687–698. https://doi.org/10.1016/S2213-2600(19)30198-5
Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20:705–706. https://doi.org/10.1093/sleep/20.9.705
Xie W, Zheng F, Song X (2014) Obstructive sleep apnea and serious adverse outcomes in patients with cardiovascular or cerebrovascular disease. Medicine 93:336–343. https://doi.org/10.1097/MD.0000000000000336
Lin CH, Perger E, Lyons OD (2018) Obstructive sleep apnea and chronic kidney disease. Curr Opin Pulm Med 24:549–554. https://doi.org/10.1097/MCP.0000000000000525
Jaimchariyatam N, Na-Rungsri K, Tungsanga S, Lertmaharit S, Lohsoonthorn V, Totienchai S (2019) Obstructive sleep apnea as a risk factor for preeclamsia-eclampsia. Sleep Breath 23:687–693. https://doi.org/10.1007/s11325-018-1758-8
Jaimchariyatam N, Tantipornsinchai W, Desudchit T, Gonlachanvit S (2016) Association between respiratory events and nocturnal gastroesophageal reflux events in patients with coexisting obstructive sleep apnea and gastroesophageal reflux disease. Sleep Med 22:33–38. https://doi.org/10.1016/j.sleep.2016.04.013
Rasak MRA, Chirakalwasan N (2016) Obstructive sleep apnea and asthma. Asian Pac J Allergy Immunol 34:265–271
Laratta CR, Ayas NT, Povitz M, Pendharkar SR (2017) Diagnosis and treatment of obstructive sleep apnea in adults. CMAJ 189:1481–1488. https://doi.org/10.1503/cmaj.170296
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 108:812–821. https://doi.org/10.1097/aln.0b013e31816d83e4
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 131:485–491. https://doi.org/10.7326/0003-4819-131-7-199910050-00002
Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545. https://doi.org/10.1093/sleep/14.6.540
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 (2016) The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. Lancet Respir Med 4:742–748. https://doi.org/10.1016/s2213-2600(16)30075-3
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 110:1689–1693. https://doi.org/10.1097/00005537-200010000-00022
Iber C, Ancoli-Israel S, Chesson A, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specifications, 1st ed. Westchester, IL: American Academy of Sleep Medicine, 2007. https://www.sleep.pitt.edu/wp-content/uploads/2020/03/The-AASM-Manual-for-Scoring-of-Sleep-and-Associated-Events-2007-.pdf. Accessed 13 March 2021
Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG (2017) Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 13(3):479–504. https://jcsm.aasm.org/doi/https://doi.org/10.5664/jcsm.6506
Spicuzza L, Caruso D, Maria GD (2015) Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis 6:273–285. 10.1177%2F2040622315590318
Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, Lévy P, Riha R, Bassetti C, Narkiewicz K, Mancia G, McNicholas WT (2013) Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J 41:523–538. https://doi.org/10.1183/09031936.00226711
Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwad RJ, Weaver EM, Weinstein MD (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adult. J Clin Sleep Med 5:263–276
Cho JHm Choi JH, Suh JD, Ryu S, Cho SH (2016) Comparison of anthropometric data between Asian and Caucasian patients with obstructive sleep apnea: a meta-analysis. Clin Exp Otorhinolaryngol. 9(1):1–7. https://doi.org/10.21053/ceo.2016.9.1.1
Guilleminault C, Stoohs R, Kim YD (1995) Upper airway sleep-disordered breathing women. Ann Int Med 122:493–501. https://doi.org/10.7326/0003-4819-122-7-199504010-00003
Neruntarat C, Chantapant S (2011) Prevalence of sleep apnea in HRH Princess Maha Chakri Srinthorn Medical Center, Thailand. Sleep Breath 15:641–648. https://doi.org/10.1007/s11325-010-0412-x
Kim J, In K, Kim J, You S, Kang K, Shim J, Lee S, Lee J, Lee S, Park C, Shin C (2004) Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Repir Crit Care Med 170:1108–1113. https://doi.org/10.1164/rccm.200404-519oc
Acknowledgements
The authors would like to extend my gratitude to King Chulalongkorn Memorial Hospital and Bangkok Christian Hospital for providing data used in the study and also thank Mr.Sermchai Chaikasetsin, who was at the time of the study, dedicated his time to help collecting data.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Supakorn Srichan, Jeerath Phannajit, and Nattapong Jaimchariyatam. The first draft of the manuscript was written by Supakorn Srichan and Somkanya Tungsanga. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. All authors declare no plagiarism, no fabrication, and no falsification.
Corresponding author
Ethics declarations
Ethics approval
This retrospective chart review study involving human participants followed the ethical standards of the Institutional and National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the Faculty of Medicine, Chulalongkorn University, approved this study (IRB number 471/62).
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Competing interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Srichan, S., Phannajit, J., Tungsanga, S. et al. The NH-OSA score in prediction of clinically significant obstructive sleep apnea among the Thai population: derivation and validation studies. Sleep Breath 27, 913–921 (2023). https://doi.org/10.1007/s11325-022-02642-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11325-022-02642-x