Simple and Unbiased OSA Prescreening: Introduction of a New Morphologic OSA Prediction Score.

An early prescreening in suspected obstructive sleep apnea (OSA) patients is desirable to expedite diagnosis and treatment. However, the accuracy and applicability of current prescreening tools is insufficient. We developed and tested an unbiased scoring system based solely on objective variables, which focuses on the diagnosis of severe OSA and exclusion of OSA. The OSA prediction score was developed (n = 150) and validated (n = 50) within German sleep center patients that were recruited as part of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC). Six objective variables that were easy to assess and highly correlated with the apnea-hypopnea index were chosen for the score, including some known OSA risk factors: body-mass index, neck circumference, waist circumference, tongue position, male gender, and age (for women only). To test the predictive ability of the score and identify score thresholds, the receiver-operating characteristics (ROC) and curve were calculated. A score ≥8 for predicting severe OSA resulted in an area under the ROC curve (ROC-AUC) of 90% (95% confidence interval: 84%, 95%), test accuracy of 82% (75%, 88%), sensitivity of 82% (65%, 93%), specificity of 82% (74%, 88%), and positive likelihood ratio of 4.55 (3.00, 6.90). A score ≤5 for predicting the absence of OSA resulted in a ROC-AUC of 89% (83%, 94%), test accuracy of 80% (73%, 86%), sensitivity of 72% (55%, 85%), specificity of 83% (75%, 89%), and positive likelihood ratio of 4.20 (2.66, 6.61). Performance characteristics were comparable in the small validation sample. We introduced a novel prescreening tool combining easily obtainable objective measures with predictive power and high general applicability. The proposed tool successfully predicted severe OSA (important due to its high risk of cardiovascular disease) and the exclusion of OSA (rarely a feature of previous screening instruments, but important for better differential diagnosis and treatment).

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© 2021 Laharnar et al.

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Outside the submitted work, PAC has an appointment to an endowed academic Chair at the University of Sydney that was created from ResMed funding. He receives no personal fees and this relationship is managed by an Oversight Committee of the University. He has received research support from ResMed, SomnoMed, Zephyr Sleep Technologies, and Bayer. He is a consultant/adviser to Zephyr Sleep Technologies, Signifier Medical Technologies, SomnoMed, ResMed, and Bayer. He has a pecuniary interest in SomnoMed related to a previous role in R&D (2004). AIP is the John Miclot Professor of Medicine. Funds for this endowment are provided by the Phillips Respironics Foundation. RS reports grants from ResMed, Inspire, CryOSA; he is on the Advisory Board for eXciteOSA and has royalties from UptoDate and Merck Manual, outside the submitted work. IF has received research grants from Löwenstein, ResMed, Weinmann and Philips at the Charite University Hospital. TP reports grants from Cidelec, grants and personal fees from Löwenstein Medical, grants from Novartis, personal fees from Jazz Pharma, Bayer Healthcare, Cerebra, Philips, and Neuwirth, speaker fee from National Sleep Foundation, outside the submitted work; and shareholder of Advanced Sleep Research, The Siestagroup GmbH, Nukute. The authors report no other conflicts of interest in this work.