Obstructive Sleep Apnea-hypopnea Syndrome Screening Scale
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Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a common sleep disorder characterized by repeated upper airway collapse during sleep, leading to apnea or hypopnea. Currently, there is not enough evidence to prove its cause. When sleeping, apnea caused by upper airway collapse and obstruction is accompanied by insufficient ventilation (apnea), snoring during sleep, sleep disorders, decreased blood oxygen saturation, daytime sleepiness, etc. In addition, it can cause a variety of complications, such as: hypoxia during sleep at night, hyperlipidemia, and then coronary heart disease, hypertension, cerebrovascular disease, diabetes, etc. In severe cases, it can cause sudden death during sleep at night, which is a health threat that cannot be ignored.But how do you know if you have sleep apnea? The OSAHS screening scale is a good method to do early screening.
OSAHS Screening Scale
The screening scale is an important tool for the initial assessment of OSAHS risk. Its core purpose is to identify high-risk groups through simple and quick questions, thereby guiding further diagnostic examinations.
There are a variety of questionnaires for further screening of obstructive sleep apnea-hypopnea syndrome (OSAHS). The NoSAS rating scale and SBQ scale are widely used, followed by the Berlin questionnaire, STOP questionnaire, and Epworth Sleepiness Scale (ESS) to assess the severity of patients’ subjective daytime sleepiness.
Other methods for diagnosing OSAHS and their advantages and disadvantages
Polysomnography (PSG)
Method: Monitor multiple physiological indicators such as EEG, respiration, blood oxygen, and ECG in a sleep laboratory, and record the apnea-hypopnea index (AHI).
Advantages: Diagnostic “gold standard”, which can comprehensively evaluate sleep structure and respiratory events.
Disadvantages: High cost, overnight hospitalization monitoring is required, and some patients may be affected by the results due to environmental discomfort.
Home Sleep Apnea Test (HSAT)
Method: Portable device monitors core indicators such as respiratory airflow, chest and abdominal movement, and blood oxygen saturation at home.
Advantages: Low cost, convenient, suitable for preliminary diagnosis of moderate to severe patients.
Disadvantages: Unable to monitor brain waves, central sleep apnea, or mild cases may be missed.
Clinical evaluation and imaging examination
Methods: Combine medical history, physical examination (such as neck circumference, maxillofacial structure), and imaging such as nasopharyngeal endoscopy, and CT/MRI to evaluate upper airway anatomical abnormalities.
Advantages: Clarify anatomical causes (such as tonsil hypertrophy, and tongue root prolapse) and guide surgical intervention.
Disadvantages: The frequency of respiratory events cannot be directly quantified and needs to be combined with functional examinations.
1.NoSAS Score Scale
| NoSAS | Item | Answer | Score |
|---|---|---|---|
|
N=Neck circumference |
How many centimeters is your neck circumference? |
_____cm |
|
|
O=Obesity |
BMI (body mass index) |
BMI=_____ |
|
|
S=Snoring |
Do you snore? |
Yes/No |
|
|
A=Age |
Age |
_ years old |
|
|
S=Sex |
Gender |
Male/Female |
|
Scoring method: This scoring scale has 5 items, which can be used for preliminary screening, with a total of 17 points. The following is a detailed classification of each item.
Scoring:
① If the neck circumference is >40 cm, 4 points, otherwise 0 points.
② BMI score calculation: BMI less than 25, 0 points; BMI greater than or equal to 25, less than 30, 3 points; BMI greater than or equal to 30, 5 points.
③ Snoring “yes” gets 2 points, “no” gets 0 points.
④ Age, age greater than 55 years old gets 4 points, less than or equal to 55 years old gets 0 points.
⑤ Gender, male gets 2 points, female gets 0 points.
The total score of NoSAS is 17 points. If the subjects score 8 points or above on the NoSAS scoring scale, it indicates that they may suffer from sleep breathing disorder.
After experimental measurement, it was found that this scale has limitations: people with small neck circumferences and light weight (low BMI) are easily overlooked and screened out. Moreover, setting the score at 7 points instead of 8 points has better sensitivity than 8 points, but the specificity is slightly lower. The DOR values of the two are 5.093 and 4.298 respectively. Therefore, setting the score cutoff at 7 points may have more diagnostic value.
2.STOP-BANG Questionnaire
Evaluation content: snoring, daytime fatigue, observed apnea, high blood pressure, BMI, age, neck circumference, gender and other indicators.
Advantages: High sensitivity (>90%), suitable for preoperative screening and initial screening of the general population.
Limitations: False positives or false negatives may occur due to subjective symptom reporting bias.
| STOP-BANG | Item |
|---|---|
|
S=Snoring |
Do you snore loudly (louder than talking or loud enough to be heard through closed doors) |
|
T=Tired |
Do you often feel tired, fatigued, or sleepy during daytime? |
|
O=Observe |
Has anyone observed you stop breathing during your sleep? |
|
P=Blood pressure |
Do you have or are you being treated for high blood pressure? |
|
B=BMI |
BMI? |
|
A=Age |
Age? |
|
N=Neck circumference |
Neck circumference? |
|
G=Gender |
Gender? |
Scoring method: This scale has a total of 8 points, each item can get a maximum of 1 point or 0 points, and the scores are divided as follows;
① For the first question, answer “yes” to get 1 point, answer “no” to get 0 point.
② For the second question, answer “yes” to get 1 point, answer “no” to get 0 point.
③ For the third question, answer “yes” to get 1 point, answer “no” to get 0 point.
④ For the fourth question, answer “yes” to get 1 point, answer “no” to get 0 point.
⑤ For the fifth question, A BMI greater than 35 was assigned a point of 1, and a BMI less than or equal to 35 was assigned a point of 0.
⑥ For the sixth question, Age greater than 50 years was assigned a score of 1, and age less than or equal to 50 years was assigned a score of 0.
⑦ For the seventh question, answer “male” to get 1 point, answer “female” to get 0 point.
By calculating the total score, subjects with a total score less than or equal to 3 points were considered to have a high risk of OSAHS. The experiment was conducted on 444 suspected OSAHS patients, and it was concluded that this scale is simple, effective, and highly accurate, with a DOR value of 2.839.
3.Epworth Sleepiness Scale(ESS)
Assessment content: The sleepiness level in 8 daily activities is scored (0-3 points), and a total score of ≥10 points indicates significant daytime sleepiness.
Advantages: It is easy to operate and can quantify the severity of the patient’s daytime sleepiness.
Limitations: It cannot be used alone to diagnose OSAHS and needs to be combined with other examinations.
The following are possible situations in your life. In addition to feeling tired, do you also doze off or fall asleep easily? Regarding these things that happen in your daily life, if these things have not happened in your life as usual recently, then think about how they will affect your life, please tick the corresponding position.
Instructions： How likely are you to doze or fall asleep in the following situations in contrast to just feeling tired?
• This refers to your usual way in recent times.
• Even if you have not done some of these things recently, try to work out how they would have
| Situation | Answer | |||
|---|---|---|---|---|
|
1.Sitting and Reading |
Never |
Rarely |
Sometimes |
Often |
|
2.Watching TV |
Never |
Rarely |
Sometimes |
Often |
|
3.Sitting inactive in a public place (e.g. a theatre or meeting) |
Never |
Rarely |
Sometimes |
Often |
|
4.As a passenger in a car without break |
Never |
Rarely |
Sometimes |
Often |
|
5.Lying down to rest during the day when circumstances permit |
Never |
Rarely |
Sometimes |
Often |
|
6.Sitting and talking to someone |
Never |
Rarely |
Sometimes |
Often |
|
7.Sitting quietly after lunch without alcohol |
Never |
Rarely |
Sometimes |
Often |
|
8.In a car, while stopped for a few minutes in traffic |
Never |
Rarely |
Sometimes |
Often |
Scoring method: The ESS scoring scale includes “0 = Never (Would never doze)”, “1 = Rarely (Slight chance of dozing)”, “2 = Sometimes (Moderate chance of dozing)”, or “3 = Often (High chance of dozing)”. The total score of this scale is 24 points, with a score range of 0 to 24 points.
If the total score is greater than or equal to 9 in the scale, it can be considered to be at risk of OSAHS.
The clinical significance of this table: On the 24-point scale, a score of >6 indicates sleepiness, >11 indicates excessive sleepiness, and >16 indicates dangerous sleepiness. The higher the ESS score, the higher the sleeping tendency or “daytime sleepiness”.
0-5 points Low-level normal daytime sleepiness
6-10 points High-level normal daytime sleepiness
11-12 points Mild excessive daytime sleepiness
13-15 points Moderate excessive daytime sleepiness
16-24 Severe excessive daytime sleepiness
Operation guide:
① A score of >6 indicates sleepiness;
② A score of >11 indicates excessive sleepiness;
③ A score of >16 indicates dangerous sleepiness;
④ The questionnaire answering time does not exceed 2 to 3 minutes.
Conclusion
Screening scales are highly effective tools for early detection of OSAHS, but their results need to be combined with objective examinations (such as PSG or HSAT) to improve diagnostic accuracy. Although PSG is the gold standard, its cost and accessibility limit its widespread application; HSAT provides a practical alternative for families and resource-limited scenarios. Through a stratified screening strategy (initial screening with scales → confirmed diagnosis with HSAT/PSG → imaging assistance), missed diagnoses can be significantly reduced, treatment decisions can be optimized, and ultimately the quality of life and long-term prognosis of patients can be improved. Future studies need to further optimize the sensitivity and specificity of the scales and promote the popularization of portable monitoring technology to achieve early diagnosis and treatment of OSAHS.
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