Cheeks appearance as a novel predictor of obstructive sleep apnea: the CASA score study.

STUDY OBJECTIVES:Four well-established predictors of obstructive sleep apnea risk are body mass index, age, gender, and neck circumference. We have previously reported cheeks appearance as an OSA predictor, which may represent a combination of such predictors in a single readily available feature. This study sought to answer the question: Is cheeks appearance an OSA risk predictor? METHODS:A prospective cross-sectional diagnostic accuracy study based on STARD. Patients undergoing polysomnography to investigate sleep complaints at a sleep clinic affiliated to a university hospital were assessed using cheeks appearance scored 0-3 for volume from and 0-3 for flaccidity to create the cheeks appearance for sleep apnea (CASA) score ranging from 0-6. Appearance was judged by three blinded and independent evaluators. RESULTS:Among 265 patients evaluated, 248 were included. Fifty-seven patients had a CASA score of 0, 191 had a CASA score between 1-6. Polysomnography diagnosed 177 of the individuals with OSA; of these 167 had altered CASA score. Sensitivity was 87%, specificity 82%, positive predictive value 94%, negative predictive value 66%, accuracy 86%. CONCLUSIONS:Our results suggest that combining volume and flaccidity of cheeks appearance in a single index may constitute a reliable OSA predictor. CASA score is a novel predictor of obstructive sleep apnea with internal validity in sleep laboratory adult population. Our findings support further studies to confirm external validity of this practical diagnostic tool. CLINICAL TRIAL REGISTRATION:Registry: ClinicalTrials.gov; Title: Cheeks Appearance as a Novel Predictor of Obstructive Sleep Apnea: The CASA Score Study (CASA); Identifier: NCT04980586; URL: https://clinicaltrials.gov/study/NCT04980586.