The predictive value of BOAH scale for screening obstructive sleep apnea in patients at a sleep clinic in Scotland

Abstract

Objectives The study aimed to evaluate the diagnostic value of an original questionnaire for obstructive sleep apnea (OSA), the BOAH scale, and its ability to prioritize patients at high risk for OSA for polysomnography (PSG) examination. Methods The analysis included 273 patients referred to the Department of Sleep Medicine of the Royal Infirmary, Edinburgh, Scotland. The BOAH scale is comprised of 5 parameters: BMI (≥ 30 kg/m2 gives 1 point, ≥ 35 kg/m2 2 points), presence of witnessed apneas during sleep (1 point), patient age ≥ 50 years (1 point), and history of hypertension (1 point). Patients were divided into three study groups depending on OSA severity defined by the apnea-hypopnea index (AHI): at least mild (AHI ≥ 5), at least moderate (AHI ≥ 15), and severe (AHI ≥ 30) OSA based on polysomnography examination. Results In the group of patients with severe OSA, the best BOAH cutoff point was 4 points based upon the Youden index. With 4 points, the area under the receiver operating characteristic (ROC) curve was 0.778 (95% CI 0.721–0.834). Sensitivity and specificity were 57% and 89%, respectively, yielding a positive and negative predictive value of 75% and 78%, respectively, for diagnosis of severe OSAS in a patient sample with a pre-test probability for severe OSA at 37%. Conclusions The BOAH scale in this group of Scottish patients performed comparably to other available questionnaires and scales while being shorter and simpler. The findings suggest that the BOAH scale should be considered as a useful instrument in OSA diagnosis and prioritization of high-risk patients for PSG examination.

The predictive values of BOAH and No-apnea score for screening obstructive sleep apnea in rotating shift worker drivers

“…Our study used the same cutoff point, the AUC was 0.679, and the Youden index was 0.36. A possible explanation for the lower AUC in our research is the difference in the mean age of the evaluated subjects: 35 years in our study and 49.4 years in the study by Gabryelska et al (2021) [ 20 ].…”

“…Therefore, the BOAH score was calculated based on the following scoring criteria: BMI (≥30 kg/m 2 –1 point; or ≥ 35 kg/m 2 –2 points), witnessed apneas during sleep, by self-report (1 point), age (≥50–1 point), and arterial hypertension (1 point). The BOAH score ranges from 0 (low risk for OSA) to 5 points (high risk for OSA) [ 20 ].…”

The B‐APNEIC score: distilling the STOP‐Bang questionnaire to identify patients at high risk for severe obstructive sleep apnoea

“…Indeed, a weighted model for the STOP‐Bang variables has been shown to potentially improve the accuracy of the tool [16]. More recently, in a study of Scottish adults suspected of OSA (n = 273), the STOP‐Bang questionnaire was distilled to develop the BOAH scale (BMI ≥30 kg.m 2 , BMI ≥35 kg.m 2 , witnessed apnoeic sleep, age ≥50 y and hypertension), which demonstrated an AUC of 0.78 (95%CI 0.72–0.83) for identifying patients with severe OSA [17]. In a larger study of Swiss adults (n = 2121), the NoSAS score (neck circumference, BMI, loud snoring, age and sex) was shown to have a model derivation AUC of 0.74 (95%CI 0.72–0.76) and a validation AUC of 0.81 (0.77–0.85) to identify individuals with clinically significant OSA [18].…”

Bariatric surgery in patients with obstructive sleep apnea

“…32 Alternative screening questionnaires are also available including abbreviated versions of the STOP-Bang score and other scoring systems. [33][34][35][36][37] Instead of a formal PSG in patients with a high pretest probability for OSA based on screening questionnaires, a type III portable sleep monitor can be considered. 38 Type III portable sleep monitors measure AHI and serve as an at-home diagnostic tool, though the severity of OSA may be underestimated and the overall diagnostic utility of this test is limited compared with a PSG.…”

“…Raising the STOP-Bang score to 6 has higher specificity (85.2%) for ruling in severe sleep apnea with lower sensitivity (37.5%) and PPV (46.9%) 32. Alternative screening questionnaires are also available including abbreviated versions of the STOP-Bang score and other scoring systems 33–37. Instead of a formal PSG in patients with a high pretest probability for OSA based on screening questionnaires, a type III portable sleep monitor can be considered 38.…”