Using anthropometric measures to screen for obstructive sleep apnea in the Sleep Heart Health Study cohort

Abstract

Study Objectives: To evaluate predictions of moderate to severe obstructive sleep apnea (MS-OSA) by the neck circumference/height ratio (NHR) and waist circumference/height ratio (WHR) and compare to the derived STOP-Bang Questionnaire (dSBQ) prediction. Methods: Included were 6,167 participants from the Sleep Heart Health Study baseline evaluation who completed polysomnograms and had anthropometric measurements and data to compute proxy dSBQitemanswers. The sample was divided randomly into derivation (n = 2,035) and validation (n = 4,132) subsets. The derivation sample was used to estimate the NHR and WHR cut points to detect MS-OSA; the validation sample was used to evaluate sensitivity and specificity. Results:Mean age was 63.1 years, and 47.2%were men for the overall sample. In the derivation sample, a cut point ≥ 0.21 for NHR yielded a sensitivity of 92.0% and a specificity of 25.0%; a cut point ≥ 0.52 for WHR yielded a sensitivity of 91.2% and a specificity of 25.0% for MS-OSA. Using the validation sample, the NHR, WHR, and dSBQ areas under the receiver operator curves were 69.8%, 65.2%, and 70.5%, respectively, for MS-OSA. There was no statistical difference with listwise comparison of the NHR and dSBQ areas under the receiver operator curves (P =.997); however, there was a significant difference between the WHR and dSBQ areas under the receiver operator curves (P = .015) for MS-OSA. Conclusions: The NHR is a viable obstructive sleep apnea screening tool comparable to the dSBQ, independent of witnessed apneas and body mass index, that can be used for different body types.