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The NH-OSA score in prediction of clinically significant obstructive sleep apnea among the Thai population: derivation and validation studies

  • Sleep Breathing Physiology and Disorders • Original Article
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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.

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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

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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.

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Authors and Affiliations

Authors

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

Correspondence to Nattapong Jaimchariyatam.

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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).

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

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The authors declare no competing interests.

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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

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