title: Validation of NoSAS score for screening of sleep-disordered breathing in a multiethnic Asian population.
abstract: OBJECTIVE
  The NoSAS score was developed to identify subjects at high risk of sleep-disordered breathing (SDB). We aimed to validate the NoSAS score in a multiethnic Asian cohort and compare its performance to the STOP-Bang and Berlin questionnaires.
  
  
  METHODS
  A sample of 242 subjects selected from a population-based cohort in Singapore completed home-based sleep testing with an Embletta device (type 3 monitor). All subjects were given the STOP-Bang and Berlin questionnaires for self-administration prior to the sleep study. The NoSAS score was subsequently calculated based on available demographic data and Berlin questionnaire responses.
  
  
  RESULTS
  The prevalence of severe SDB, defined as an apnea-hypopnea index cutoff of ≥30 events/h, was 10.7%. The number of subjects who were classified as high risk by the NoSAS score and STOP-Bang and Berlin questionnaires were 76 (31.4%), 89 (36.8%), and 79 (32.6%), respectively. The sensitivity, specificity, and negative and positive predictive values of the NoSAS score to predict severe SDB were 69.2, 73.1, 95.2, and 23.7%, respectively. The STOP-Bang and Berlin questionnaires performed similarly to the NoSAS score, with area under the curve (AUC) values of all three questionnaires clustered around 0.682-0.748. Compared to the STOP-Bang (94.8%) and Berlin questionnaires (96.3%), the NoSAS score (95.2%) had equally high negative predictive value in ruling out severe SDB.
  
  
  CONCLUSIONS
  The NoSAS score performed similarly to the STOP-Bang and Berlin questionnaires in a multiethnic Asian cohort. All three questionnaires had high negative predictive values in ruling out severe SDB and may have utility as screening tools.
authors.affiliation: Department of Respiratory Medicine, Jurong Health Services, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore. ayytan@gmail.com.
authors.forename: Adeline
authors.identifier: http://orcid.org/0000-0003-0261-2708
authors.initials: A
authors.lastname: Tan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
authors.forename: Yueheng
authors.initials: Y
authors.lastname: Hong
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
authors.forename: Linda W L
authors.initials: LWL
authors.lastname: Tan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.
authors.forename: Rob M
authors.initials: RM
authors.lastname: van Dam
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.|Department of Cardiology, National University Heart Centre, Singapore, Singapore.
authors.forename: Yan Yi
authors.initials: YY
authors.lastname: Cheung
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.|Department of Cardiology, National University Heart Centre, Singapore, Singapore.
authors.forename: Chi-Hang
authors.initials: CH
authors.lastname: Lee
mesh_terms: D019540:Area Under Curve; D044466:Asian People / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012846:Singapore; D012890:Sleep; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000503:physiopathology*
keywords: Asian; Berlin questionnaire; NoSAS score; STOP-Bang; Sleep-disordered breathing