Screening for obstructive sleep apnea: comparing the American Academy of Sleep Medicine proposed criteria with the STOP-Bang, NoSAS, and GOAL instruments.
Level 3 - non-randomized controlled study
Cross-sectional diagnostic validation cohort compared against gold-standard polysomnography
PubMed 36872648 · doi:10.5664/jcsm.10546
What was done
This cross-sectional diagnostic accuracy study evaluated the performance of the 2017 American Academy of Sleep Medicine (AASM 2017) screening criteria compared with three validated instruments: NoSAS, STOP-Bang, and GOAL. The cohort included 4,499 adults undergoing overnight polysomnography at a single referral center between July 2019 and December 2021. High risk under AASM 2017 was defined as excessive daytime sleepiness plus at least two of three criteria: loud snoring; observed apnea, gasping, or choking; and hypertension. Obstructive sleep apnea (OSA) severity thresholds based on the apnea-hypopnea index were 5.0, 15.0, and 30.0 events/h. Predictive performance was evaluated using area under the receiver operating characteristic curve (AUC) and contingency tables.
What was found
For any OSA severity, AASM 2017 criteria showed a sensitivity of 31.0% to 40.6% and a specificity of 80.8% to 89.6%. AASM 2017 had higher specificity but markedly lower sensitivity across all severity cutoffs compared to GOAL, STOP-Bang, and NoSAS. GOAL, STOP-Bang, and NoSAS each achieved AUC values > 0.7 for any OSA severity, significantly outperforming AASM 2017 (all P < .001). Performance was similar among GOAL, STOP-Bang, and NoSAS across all OSA severity levels (all P > .05). Specific numerical sensitivities, specificities, and exact AUC values for the comparator tools were not reported in the abstract.
Why it matters
The AASM 2017 screening criteria miss a substantial proportion of patients with OSA due to low sensitivity, demonstrating that STOP-Bang, NoSAS, and GOAL are far more effective screening tools in clinical referral populations.
Limits
The study was conducted in a single referral center cohort, introducing referral bias and limiting generalizability to primary care or general community settings. Numerical diagnostic metrics (exact AUCs, sensitivity, specificity) for the comparator questionnaires were omitted from the abstract.
Cited by
- supports Severe sleep apnea is clinically defined as having 30 or more respiratory events per hour.
- supports Severe sleep apnea is defined clinically as 30 or more respiratory events per hour.