title: The nasal obstruction symptom evaluation survey as a screening tool for obstructive sleep apnea.
abstract: OBJECTIVE
  To determine if clinical data and Nasal Obstruction Symptom Evaluation (NOSE) scores can be used to identify patients at risk for obstructive sleep apnea (OSA).
  
  
  METHODS
  Intake surveys using the NOSE, Epworth Sleepiness Scale (ESS), and Snore Outcomes Scale (SOS) were administered to new patients visiting a facial plastic surgery practice and a rhinology practice.
  
  
  METHODS
  An academic facial plastic surgery practice and an academic rhinology practice.
  
  
  METHODS
  New patients to both practices.
  
  
  METHODS
  NOSE score and presence of septal deviation.
  
  
  RESULTS
  The odds ratio (OR) for an ESS score higher than 10 was 2.98 (95% confidence interval [CI], 1.17-7.57) when snoring was present; 5.5 (95% CI, 1.35-22.58) when the NOSE score was 10 or higher; and 3.3 (95% CI, 0.98-11.0) when a deviated septum was found on clinical examination. The probability of an elevated ESS score was 88% when all 3 factors were present and 56% when the NOSE score was not elevated. Receiver operating characteristic analysis with predictors "snore" and NOSE score of 10 or higher had an area under the curve of 0.72. With a probability cutoff of 0.5, the sensitivity was 30%, and the specificity 90%.
  
  
  CONCLUSIONS
  Sinonasal surgery is among the most common outpatient procedures performed in the United States each year. Many patients undergoing sinonasal surgery have undiagnosed OSA or nasal obstruction, a known risk factor for OSA. Patients with OSA have unique perioperative needs. In patients with nasal obstruction, a deviated septum, and/or snoring, there is an association between the NOSE score and the ESS score. The NOSE survey may serve as a simple screening instrument instead of the ESS for patients at risk for undiagnosed OSA and special perioperative needs.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, 4949 Eastern Ave, A5W, 595A, Baltimore, MD 21224, USA. Learnes2@jhmi.edu
authors.forename: Lisa
authors.initials: L
authors.lastname: Ishii
authors.forename: Andres
authors.initials: A
authors.lastname: Godoy
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
mesh_terms: D020920:Dyssomnias / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015508:Nasal Obstruction / Q000175:diagnosis*; D009300:Nasal Septum / Q000002:abnormalities; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D012913:Snoring / Q000209:etiology; D011795:Surveys and Questionnaires