The Nasal Obstruction Symptom Evaluation Survey as a Screening Tool for Obstructive Sleep Apnea

OBJECTIVE: To determine if clinical data and Nasal Obstruction Symptom Evaluation (NOSE) scores can be used to identify patients at risk for obstructive sleep apnea (OSA). DESIGN: Intake surveys using the NOSE, Epworth Sleepiness Scale (ESS), and Snore Outcomes Scale (SOS) were administered to new patients visiting a facial plastic surgery practice and a rhinology practice. SETTING: An academic facial plastic surgery practice and an academic rhinology practice. PATIENTS: New patients to both practices. MAIN OUTCOME MEASURES: NOSE score and presence of septal deviation. RESULTS: The odds ratio (OR) for an ESS score higher than 10 was 2.98 (95% confidence interval [CI], 1.17-7.57) when snoring was present; 5.5 (95% CI, 1.35-22.58) when the NOSE score was 10 or higher; and 3.3 (95% CI, 0.98-11.0) when a deviated septum was found on clinical examination. The probability of an elevated ESS score was 88% when all 3 factors were present and 56% when the NOSE score was not elevated. Receiver operating characteristic analysis with predictors "snore" and NOSE score of 10 or higher had an area under the curve of 0.72. With a probability cutoff of 0.5, the sensitivity was 30%, and the specificity 90%. CONCLUSIONS: Sinonasal surgery is among the most common outpatient procedures performed in the United States each year. Many patients undergoing sinonasal surgery have undiagnosed OSA or nasal obstruction, a known risk factor for OSA. Patients with OSA have unique perioperative needs. In patients with nasal obstruction, a deviated septum, and/or snoring, there is an association between the NOSE score and the ESS score. The NOSE survey may serve as a simple screening instrument instead of the ESS for patients at risk for undiagnosed OSA and special perioperative needs.