title: The NAMES assessment: a novel combined-modality screening tool for obstructive sleep apnea.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) remains underdiagnosed, despite our understanding of its impact on general health. Current screening methods utilize either symptoms or physical exam findings suggestive of OSA, but not both. The purpose of this study was to develop a novel screening tool for the detection of OSA, the NAMES assessment (neck circumference, airway classification, comorbidities, Epworth scale, and snoring), combining self-reported historical factors with physical exam findings.
  
  
  METHODS
  Subjects were adults without previously diagnosed OSA, referred to a community sleep center for suspicion of OSA. General health, Epworth Sleepiness Scale (ESS), and Berlin questionnaires were completed, and a physical exam focusing on modified Friedman (MF) grade, body mass index (BMI), and neck circumference (NC) was performed prior to polysomnography. OSA was defined by a respiratory disturbance index ≥15. Each variable was dichotomized, and cutoff values were determined for the NAMES tool in a pilot group of 150 subjects. The NAMES score was calculated from NC, MF, comorbidities, ESS, and loud snoring values. The performances of the NAMES, Berlin questionnaire, and ESS screening tests in predicting OSA were then compared in a validation group of 509 subjects.
  
  
  RESULTS
  In the pilot population, the cutoff value for the composite NAMES tool was calculated at ≥3 points. In the validation group, NAMES demonstrated similar test characteristics to the Berlin questionnaire, and sensitivity was better than that seen with the Epworth scale. The addition of BMI and gender to the tool improved screening characteristics.
  
  
  CONCLUSIONS
  The NAMES assessment is an effective, inexpensive screening strategy for moderate to severe OSA.
authors.affiliation: Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA. shyammd@gmail.com
authors.forename: Shyam
authors.initials: S
authors.lastname: Subramanian
authors.forename: Sean E
authors.initials: SE
authors.lastname: Hesselbacher
authors.forename: Raymond
authors.initials: R
authors.lastname: Aguilar
authors.forename: Salim R
authors.initials: SR
authors.lastname: Surani
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D000886:Anthropometry / Q000379:methods; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D010808:Physical Examination; D017286:Polysomnography; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D012913:Snoring / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013781:Texas