Screening for obstructive sleep apnea: comparing the American Academy of Sleep Medicine proposed criteria with the STOP-Bang, NoSAS, and GOAL instruments.

STUDY OBJECTIVES: To evaluate the performance of the 2017 American Academy of Sleep Medicine criteria (AASM2017 ) in screening obstructive sleep apnea (OSA), and compare with three other validated instruments: NoSAS score, STOP-Bang, and GOAL questionnaires.

METHODS: From July 2019 to December 2021, 4,499 adults undergoing overnight polysomnography (PSG) were included. The AASM2017 instrument considers an increased high risk for moderate-to-severe OSA in the presence of excessive daytime sleepiness and at least two of the following three criteria: loud snoring; observed apnea, gasping, or choking; and hypertension. OSA severity was based on PSG-derived apnea/hypopnea index (AHI) cut-offs: 5.0/h, 15.0/h, and 30.0/h. Predictive performance was evaluated by the area under the curve (AUC) and contingency tables.

RESULTS: When screening for any OSA severity, AASM2017 displayed a sensitivity of 31.0-40.6% and a specificity of 80.8-89.6%. For all AHI thresholds, AASM2017 , unlike the GOAL, STOP-Bang, and NoSAS, exhibited superior specificity but markedly lower sensitivity. GOAL, STOP-Bang, and NoSAS, but not AASM2017 criteria, emerged as an adequate screening tool for any OSA severity (all AUCs > 0.7) and performed significantly better than AASM2017 in predicting any OSA severity (all p-values < 0.001). For all severity OSA levels, GOAL, STOP-Bang, and NoSAS displayed similar performance when compared to each other (all p-values > 0.05).

CONCLUSIONS: GOAL, STOP-Bang, and NoSAS instruments, but not AASM2017 criteria, emerge as useful OSA screening tools in a large referral single-center clinical cohort.