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Volume 14 No. 02
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Accepted Papers

Scientific Investigations

Validation of the NoSAS Score for the Screening of Sleep-Disordered Breathing: A Hospital-Based Retrospective Study in China

Cheng Hong, MD1; Riken Chen, MM1,2; Simin Qing, MM1; Ailing Kuang, MM1,3; HuaJing Yang, MB4; Xiaofen Su, MM1; Dongxing Zhao, MD1; Kang Wu, MD1; Nuofu Zhang, MM1
1State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China; 2The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China; 3The Fifth People's Hospital of Dongguan, Dongguan, China; 4Guangzhou Medical University, Guangzhou, China

Study Objectives:

This study was conducted to validate the NoSAS score in clinical populations and to compare it with the Berlin, STOP, and STOP-Bang questionnaires, as well as the Epworth Sleepiness Scale (ESS), in screening for sleep-disordered breathing (SDB).


A retrospective analysis was conducted of all patients aged 18 to 80 years who had completed a full-night polysomnography (PSG) at the sleep center of the First Affiliated Hospital of Guangzhou Medical University from October 2012 to November 2016. Patients who had incomplete or unanswered questionnaires were excluded. The data for the NoSAS score, ESS, STOP, STOP-Bang, and Berlin questionnaires were collected, after which the NoSAS score was compared against the other questionnaires for SDB screening.


A total of 2,208 participants were enrolled in this study. The NoSAS scores, which ranged from 0 to 17 and allocated a threshold of 8 points, identified individuals at risk of clinically significant SDB (defined as an apnea-hypopnea index [AHI] cutoff of ≥ 20 events/h), with an area under the curve (AUC) of 0.707. The NoSAS score performed significantly better than the STOP (AUC 0.655) and STOP-Bang (AUC 0.704) questionnaires and the ESS (AUC 0.642), and it was at par with the Berlin (AUC 0.697) scores for SDB screening. A significant correlation was found between the AHI and NoSAS score (r = .386, P < .001).


The NoSAS score is a simple, efficient, and easy method for screening SDB in the clinical setting, especially in moderate to severe SDB.

It demonstrates a moderately high level of sensitivity for SDB.


Hong C, Chen R, Qing S, Kuang A, Yang HJ, Su X, Zhao D, Wu K, Zhang N. Validation of the NoSAS score for the screening of sleep-disordered breathing: a hospital-based retrospective study in China. J Clin Sleep Med. 2018;14(2):191–197.

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