Screening Questionnaires Show High Sensitivity in OSA Diagnosis, Suggests Study

Although overnight polysomnography (PSG)-derived apnea–hypopnea index (AHI) is the diagnostic gold standard for OSA, high costs limit accessibility, and previous research on standalone tools lacked multimodal evaluation in a single cohort. Addressing this gap, lead author Amrit Thapa and colleagues from Armed Forces Medical College, Pune, evaluated STOP-BANG, EPSS, and Berlin Questionnaires alongside acoustic pharyngometry (AP) and body mass index (BMI) metrics in adults referred for oral appliance therapy.

Therefore, the prospective cross-sectional study evaluated 72 adults with polysomnography-confirmed obstructive sleep apnea referred for oral appliance therapy at a tertiary institution, excluding patients with psychiatric or sleep-altering conditions. Evaluating STOP-BANG, EPSS, Berlin Questionnaires, anthropometrics, and acoustic pharyngometry, primary endpoints assessed diagnostic accuracy (area under the curve, sensitivity, specificity) for moderate-to-severe disease (apnea–hypopnea index ≥15 events/hour), alongside secondary Spearman correlation analyses.

Key clinical findings of the study include:

• STOP-BANG Superiority: The study established STOP-BANG (cutoff ≥6.5) as the most sensitive tool for moderate-to-severe OSA (AUC: 0.732, 79.6% sensitivity, 66.7% specificity; ρ = 0.380, p = 0.001).
• EPSS Precision: The study demonstrated that EPSS (cutoff ≥10.5) provided strong diagnostic balance (AUC: 0.726, 75.0% sensitivity, 75.0% specificity; ρ = 0.363, p = 0.002). •
• Berlin Questionnaire Utility: The study noted moderate predictive value for the Berlin Questionnaire (cutoff ≥6.5; AUC: 0.679, 68.5% sensitivity, 61.1% specificity; ρ = 0.295, p = 0.012).
• Acoustic Pharyngometry Limitations: The study revealed that standalone AP had limited accuracy (cutoff ≥17.48 cm², AUC: 0.566, 66.0% sensitivity, 42.1% specificity; ρ = −0.006, p = 0.961), despite inverse associations with age (ρ = −0.279) and weight (ρ = −0.357).
• Age and Body Mass Dynamics: The study observed that advancing age correlated significantly with AHI severity (ρ = 0.368, p = 0.001), while BMI correlated with EPSS sleepiness scores (ρ = 0.305, p = 0.009) but not directly with AHI.

The results suggest that STOP-BANG (cutoff ≥6.5; 79.6% sensitivity, AUC: 0.732) and EPSS (cutoff ≥10.5; 75.0% sensitivity, AUC: 0.726) serve as the most reliable screening tools for moderate-to-severe OSA, whereas standalone static acoustic pharyngometry offers limited predictive value (AUC: 0.566).

Thus, the study concludes clinicians can integrate validated screening questionnaires with anthropometric measurements to facilitate early risk stratification and optimize PSG referrals in resource-constrained environments.

Although limited by a single-center cross-sectional design and a modest sample of 72 participants, these findings highlight the value of future prospective research evaluating dynamic upper airway behavior during sleep alongside multimodal screening frameworks.

Reference

Thapa A, Nehru TK, Chopra M, Ray S, Walia BS, Viswambaran M. Assessment of Screening Scores and Upper Airway Metrics as Diagnostic Alternatives to Polysomnography in Obstructive Sleep Apnea. Indian Journal of Sleep Medicine. 2026;21(3):105–111.