SONA Score Outperforms Existing Tools in Detecting Obstructive Sleep Apnea

The SONA scoring system is an easy-to-administer and effective screening tool for identifying individuals at risk for obstructive sleep apnea (OSA), according to results published in Journal of Sleep Research.

Researchers developed a simple screening questionnaire for OSA using data from the Bhopal Epidemiological Sleep Study cohort. Healthy participants, aged 18 to 80 years, underwent polysomnography at a tertiary care hospital and completed standard questionnaires to assess daytime sleepiness as a measure of OSA risk. Craniofacial and anthropometric measurements, including body mass index, were also collected. Sleep studies were scored per American Academy of Sleep Medicine guidelines, and OSA severity was defined by an apnea-hypopnea index (AHI).

A total of 1015 patients were included in the analysis, of whom 55.8% were men, median age was 40 years, and median BMI was 23.5. Overall, 75.9% of participants had mild-to-severe OSA (AHI, ≥5 events per hour), 30.5% had moderate-to-severe OSA (AHI, ≥15 events per hour), and 10.1% had severe OSA (AHI, ≥30 events per hour).

Complete data were available for 976 participants, from which 4 theory-formed models, with accuracy above 75%, were developed. These models incorporated variables from baseline demographics, anthropometry, symptoms, and comorbidities. The model with the highest sensitivity, negative predictive value, and positive likelihood ratio was used to develop the simplified risk score, SONA. Total SONA score ranged from 0 to 11, with different variables allocated points:

• 3 points allocated for snoring
• 3 points allocated for waist circumference greater than 93 cm in men and 85 cm in women
• 3 points allocated for neck circumference greater than 37 cm in men and 32 cm in women
• 2 points allocated for age greater than 35 years in men and 45 years in women

The SONA system demonstrated superior performance compared with other screening tools, including the Berlin Questionnaire, STOPBANG, and NoSAS, with an area under the curve of 0.83 vs 0.72, 0.77, and 0.70, respectively (P <.001 for all). At cutoff scores of 5, 6, and 8, SONA achieved sensitivities of 73%, 64%, and 49%, with corresponding specificities of 78%, 88%, and 94%.

Study limitations include a lack of external validation in independent populations.

“[The SONA score] shows improved diagnostic performance over existing tools in detecting moderate-to-severe OSA and has strong potential for deployment in community and primary care settings,” the researchers concluded.