Validation and diagnostic performance of the novel B-APNEIC score for predicting severe obstructive sleep apnoea: a cross-sectional study in an Australian population.

Abstract

The STOP-BANG questionnaire assesses the peri-operative risk of obstructive sleep apnoea and relies on subjective components, which limit its reliability. The B-APNEIC score was proposed as a more objective alternative, incorporating just four STOP-BANG variables: BMI > 35 kg.m^-2; arterial blood pressure; neck circumference > 40 cm; and witnessed breathing interruptions. This study aimed to evaluate the predictive performance of the B-APNEIC score in an Australian sleep clinic population. These findings would have important implications for use in the pre-operative screening of obstructive sleep apnoea. We enrolled participants referred for overnight diagnostic polysomnography. The STOP-BANG questionnaire was administered and the B-APNEIC score was extracted. The primary outcome was the predictive ability of a B-APNEIC score ≥ 3 to detect severe obstructive sleep apnoea. Performance metrics were compared with a STOP-BANG score ≥ 5. Among 274 patients, the B-APNEIC score showed a sensitivity of 84% (95%CI 75-90%), specificity of 60% (95%CI 52-67%), positive predictive value of 56% (95%CI 48-64%) and negative predictive value of 86% (95%CI 78-91%) for predicting severe obstructive sleep apnoea. Compared with the STOP-BANG score, the B-APNEIC score showed superior sensitivity (84% vs. 73%); positive predictive value (56% vs. 52%); negative predictive value (86% vs. 78%); Youden Index (0.43 vs. 0.32); and area under the receiver operating characteristic curve (0.72 (95%CI 0.66-0.77) vs. 0.66 (95%CI 0.60-0.72); p = 0.02). Both scores had similar specificity (59%). The B-APNEIC score showed strong predictive accuracy for severe obstructive sleep apnoea and could serve as a simple, objective alternative to STOP-BANG. While further validation in surgical populations is warranted, these findings support its use in pre-operative screening for obstructive sleep apnoea.