Patient-Performed Neck Encirclement Within the NoSAS Score: Score Availability and Diagnostic Performance in a Tertiary Sleep Centre.
6 affiliations
- 1Center for Sleep Medicine, Croix-Rousse Hospital, Hospices Civils De Lyon, Lyon, France.
- 2Division of Pulmonary Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
- 3Center for Investigation and Research in Sleep, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- 4Lyon Neuroscience Research Center, PAM Team, INSERM U1028 / CNRS UMR 5292 / Lyon 1 University, Lyon, France.
- 5Grenoble Alpes University, HP2 Laboratory (Hypoxia Pathophysiology), INSERM U1300, Grenoble, France.
- 6Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon, Lyon, France.
Abstract
Background
Obstructive sleep apnea (OSA) is highly prevalent, and early identification remains a major public health challenge. The NoSAS score is a simple and validated screening tool, incorporating neck circumference >40 cm. However, neck circumference measurement may be inconsistently performed in routine practice. Patient-performed neck encirclement, an equipment-free hand-based maneuver, may represent a pragmatic alternative.Methods
We conducted a retrospective analysis of prospectively collected routine clinical data including 449 consecutive patients referred for suspected OSA in a tertiary sleep center (Lyon, France) between September and December 2025. Neck circumference and Patient-performed manual neck encirclement were assessed at the same anatomical level. Diagnostic performance was evaluated for apnea-hypopnea index (AHI) thresholds ≥15 and ≥30 events·h⁻¹. A modified NoSAS score incorporating patient-performed neck encirclement (NoSAS hand) was compared with the standard score. In paired complete-case comparisons, diagnostic estimates and between-score differences were reported with 95% confidence intervals and McNemar tests.Results
Patient-performed neck encirclement was substantially more available than measured neck circumference (94.0% vs 71.3%) and NoSAS hand was calculable more often than standard NoSAS (91.3% vs 68.8%). In the paired complete-case cohort (n=305), at AHI ≥15/h, sensitivity and specificity differences (NoSAS hand minus standard NoSAS) were 0.0% (95% CI -1.9 to 1.9) and +1.0% (95% CI -2.0 to 5.1), respectively; corresponding differences at AHI ≥30/h were 0.0% (95% CI -2.5 to 2.5) and +0.5% (95% CI -1.6 to 2.7).Conclusions
Patient-performed neck encirclement is a simple, equipment-free alternative to measured neck circumference that substantially improves the feasibility of NoSAS implementation while preserving diagnostic performance. In this tertiary sleep-centre workflow, patient-performed neck encirclement was recorded more often than measured neck circumference and increased NoSAS score availability; paired point estimates of sensitivity and specificity at AHI ≥15/h and ≥30/h differed little between scores.
Related
- Diagnostic Performance of Different AI Tools for Chest Radiography: A CT-Anchored Per-Abnormality Analysis in a Tertiary Referral Center.
- Acute effects of bench press conditioning performed with different velocity-loss thresholds on punch performance in elite adolescent boxers.
- Red Cell Distribution Width-to-Platelet Count Ratio as an Early Marker of Severity in Acute Pancreatitis: A Diagnostic Accuracy Study at a Tertiary Care Center
- Low energy availability in recreational high-intensity functional training athletes: associations with health and performance outcomes
- Twenty-one years of cutaneous melanoma: stage shift, anatomical patterns and diagnostic trends from a Southern European tertiary center
BibTeX
@article{kassir2026patientperformed,
title = {{Patient-Performed Neck Encirclement Within the NoSAS Score: Score Availability and Diagnostic Performance in a Tertiary Sleep Centre.}},
author = {Sarah Kassir and Claudio Rabec and Raphael Heinzer and Christophe Von Garnier and Lina Latreche and Sabrina Hajji and Francois Ricordeau and Emeric Stauffer and Laure Peter-Derex and Pierre Tankéré},
journal = {Nature and science of sleep},
year = {2026},
month = oct,
doi = {10.2147/nss.s646897},
url = {https://europepmc.org/article/MED/42921212},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Patient-Performed Neck Encirclement Within the NoSAS Score: Score Availability and Diagnostic Performance in a Tertiary Sleep Centre.
AU - Sarah Kassir
AU - Claudio Rabec
AU - Raphael Heinzer
AU - Christophe Von Garnier
AU - Lina Latreche
AU - Sabrina Hajji
AU - Francois Ricordeau
AU - Emeric Stauffer
AU - Laure Peter-Derex
AU - Pierre Tankéré
PY - 2026
DA - 2026/10/19
JO - Nature and science of sleep
DO - 10.2147/nss.s646897
UR - https://europepmc.org/article/MED/42921212
AB - Background Obstructive sleep apnea (OSA) is highly prevalent, and early identification remains a major public health challenge. The NoSAS score is a simple and validated screening tool, incorporating neck circumference >40 cm. However, neck circumference measurement may be inconsistently performed in routine practice. Patient-performed neck encirclement, an equipment-free hand-based maneuver, may represent a pragmatic alternative.Methods We conducted a retrospective analysis of prospectively collected routine clinical data including 449 consecutive patients referred for suspected OSA in a tertiary sleep center (Lyon, France) between September and December 2025. Neck circumference and Patient-performed manual neck encirclement were assessed at the same anatomical level. Diagnostic performance was evaluated for apnea-hypopnea index (AHI) thresholds ≥15 and ≥30 events·h⁻¹. A modified NoSAS score incorporating patient-performed neck encirclement (NoSAS hand) was compared with the standard score. In paired complete-case comparisons, diagnostic estimates and between-score differences were reported with 95% confidence intervals and McNemar tests.Results Patient-performed neck encirclement was substantially more available than measured neck circumference (94.0% vs 71.3%) and NoSAS hand was calculable more often than standard NoSAS (91.3% vs 68.8%). In the paired complete-case cohort (n=305), at AHI ≥15/h, sensitivity and specificity differences (NoSAS hand minus standard NoSAS) were 0.0% (95% CI -1.9 to 1.9) and +1.0% (95% CI -2.0 to 5.1), respectively; corresponding differences at AHI ≥30/h were 0.0% (95% CI -2.5 to 2.5) and +0.5% (95% CI -1.6 to 2.7).Conclusions Patient-performed neck encirclement is a simple, equipment-free alternative to measured neck circumference that substantially improves the feasibility of NoSAS implementation while preserving diagnostic performance. In this tertiary sleep-centre workflow, patient-performed neck encirclement was recorded more often than measured neck circumference and increased NoSAS score availability; paired point estimates of sensitivity and specificity at AHI ≥15/h and ≥30/h differed little between scores.
SN - 1179-1608
ER -