Open AccessSAS score: Targeting high-specificity for efficient population-wide monitoring of obstructive sleep apnea
Author(s) -
Alexandru Topîrceanu,
Mihai Udrescu,
Lucreţia Udrescu,
Carmen Ardelean,
Rodica Dan,
Daniela Reisz,
Ştefan Mihăicuţă
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0202042
Subject(s) - medicine , cohort , obstructive sleep apnea , polysomnography , population , hypopnea , anthropometry , apnea , environmental health
Proposal This paper investigates a novel screening tool for Obstructive Sleep Apnea Syndrome (OSAS), which aims at efficient population-wide monitoring. To this end, we introduce SAS score which provides better OSAS prediction specificity while maintaining a high sensitivity. Methods We process a cohort of 2595 patients from 4 sleep laboratories in Western Romania, by recording over 100 sleep, breathing, and anthropometric measurements per patient; using this data, we compare our SAS score with state of the art scores STOP-Bang and NoSAS through area under curve (AUC), sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also evaluate the performance of SAS score by considering different Apnea–Hypopnea Index (AHI) diagnosis cut-off points and show that custom refinements are possible by changing the score’s threshold. Results SAS score takes decimal values within the interval (2, 7) and varies linearly with AHI; it is based on standardized measures for BMI, neck circumference, systolic blood pressure and Epworth score. By applying the STOP-Bang and NoSAS questionnaires, as well as the SAS score on the patient cohort, we respectively obtain the AUC values of 0.69 (95% CI 0.66-0.73, p < 0.001), 0.66 (95% CI 0.63-0.68, p < 0.001), and 0.73 (95% CI 0.71-0.75, p < 0.001), with sensitivities values of 0.968, 0.901, 0.829, and specificity values of 0.149, 0.294, 0.359, respectively. Additionally, we cross-validate our score with a second independent cohort of 231 patients confirming the high specificity and good sensitivity of our score. When raising SAS score ’s diagnosis cut-off point from 3 to 3.7, both sensitivity and specificity become roughly 0.6. Conclusions In comparison with the existing scores, SAS score is a more appropriate screening tool for monitoring large populations, due to its improved specificity. Our score can be tailored to increase either sensitivity or specificity, while balancing the AUC value.