Indian Journal of Sleep Medicine

Register      Login

VOLUME 11 , ISSUE 1 ( January-March, 2016 ) > List of Articles


Role of Adjusted Neck Circumference Score for Screening of Obstructive Sleep Apnea

Deepthi Laldayal

Keywords : Polysomnography, Pre-test probability scores, Apnoea hypopnoea index (AHI), Adjusted neck circumference score

Citation Information : Laldayal D. Role of Adjusted Neck Circumference Score for Screening of Obstructive Sleep Apnea. Indian Sleep Med 2016; 11 (1):30-35.

DOI: 10.5958/0974-0155.2016.00006.1

License: NA

Published Online: 01-03-2014

Copyright Statement:  NA


Background: Obstructive sleep apnoea (OSA) is a common medical condition diagnosed by polysomnography (PSG). The long waiting timefor PSG prompted researchers to make various pre-test probability scores for triaging the need for PSG. While most scores were formulated and evaluated in preoperative cases, modified sleep apnoea clinical score (SACS), the adjusted neck circumference score (ANCS), was also assessed for pre-test probability testing in OSA. This study was undertaken to explore the role of ANCS in our clinical setting. Methods: Retrospective analysis of 113 patients with an apnoea hypopnoea index (AHI) of more than 5/hour on PSG was performed. The age and sex distribution was studied. ANCS, SACS and ESS were reviewed and correlated with AHI.Descriptive and analytical statistical analysis was applied. Results: Hundred and thirteen cases of OSA consisted of 82 men and 31 women were taken. Average AHI of the study group was found to be 34.6 (22.7) per hour. Twenty-six, 34, 53 patients had mild, moderate, severe OSA, respectively. The mean AHI in the mild, moderate, and severe OSA groups were 10.87, 21.19, and 54.21 per hour, respectively. Mean ANCS and SACS were found to be 47.8 (4.7) and 17.8 (12.9), respectively. ANCS of 43 or more could identify 89.3% of cases while SACS was positive (>8) in only 76%. ANCS severity did not correlate with the severity of OSA. Screening patients with ANCS and ESS (>10) could identify all cases of moderate to severe OSA. Conclusion: It is proposedthat ANCS in adjunct with ESS has the potential to be a simple screening tool for OSA.

PDF Share
  1. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton health study. Sleep2008; 31(8):1079–85.
  2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middleaged adults. N Engl J Med 1993; 328(17):1230–5.
  3. ICSD 3 Online Version – American Academy of Sleep Medicine (AASM) AASM. Available from: http:// [Last accessed on 2016Aug5]
  4. Rosenthal LD, Dolan DC. The Epworth sleepiness scale in the identification of obstructive sleep apnea. J Nervous Mental dis 2008;196(5):429–31.
  5. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middleaged men and women. Sleep1997; 20(9):705–6.
  6. Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med 1994;150:1279–85.
  7. Flemons WW. Obstructive sleep apnea. N Engl J Med 2002 Aug 15;347(7):498–504.
  8. Wyckoff CC, O'Donnell AE. Assessing the adjusted neck circumference sleep apnea screening score in patients clinically suspected to be at high risk of obstructive sleep apnea. CHEST J.2007;132(4_Meeting Abstracts):649.
  9. Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, Nischal N, Sethi P, Behera D, Bhatia M, Ghoshal AG. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014. Lung India: official organ of Indian Chest Society. 2015 Jul;32(4):422.
  10. Kheirandish-Gozal L. Cardiovascular morbidity in obstructive sleep apnea: oxidative stress, inflammation, and much more. Am J Respir Crit Care Med 2008. 177(4):369– 75
  11. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131:485–91.
  12. Fidan H, Fidan F, Unlu M, Ela Y, Ibis A, Tetik L. Prevalence of sleep apnoea in patients undergoing operation. Sleep Breath 2006; 10:161–5.
  13. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavnathan S, Islam S et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiol2008;108:812–21.
  14. Ramachandran SK, Kheterpal S, Consens F, Shanks A, Doherty TM, Morris M, et al. Derivation and validation of a simple perioperative sleep apnea prediction score. Anesth Analg2010; 110:1007–15.
  15. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am JResp Crit Care Med 2002;165(9):1217–39.
  16. Sharma SK, Ahluwalia G. Epidemiology of adult obstructive sleep apnoea syndrome in India. Ind J Med Res 2010;131(2):171.
  17. Ware JC, McBrayer RH, Scott JA. Influence of sex and age on duration and frequency of sleep apnea events. Sleep2000; 23(2):165–70.
  18. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middleaged adults. N Engl J Med 1993; 328(17):1230–5.
  19. Redline S, Kump K, Tishler PV, Browner I, Ferrette V. Gender differences in sleep disordered breathing in a communitybased sample. Am J Respir Crit Care Med 1994; 149 :722–6.
  20. Hla KM, Young TB, Bidwell T, Palta M, Skatrud JB, Dempsey J. Sleep apnea and hypertension. A population-based study. Ann Intern Med 1994; 120(5):382–8.
  21. Shahar E, Redline S, Young T, Boland LL, Baldwin CM, Nieto FJ, et al. Hormone replacement therapy and sleepdisordered breathing. Am J Respir Crit Care Med 2003; 167(9):1186–92.
  22. Young T, Finn L, Austin D, Peterson A. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med 2003; 167(9):1181–5.
  23. Iman Hassan El-Sayed. Comparison of four sleep questionnaires for screening obstructive sleep apnea. Egyptian J Chest Dis Tuberculosis 2012; 61: 433–41.
  24. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14(6):540–5.
  25. Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea: the Epworth sleepiness scale. Chest 1993 ;103(1):30–6.
  26. Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 2000 ;118(2):372–9.
  27. Nubé M. The Asian enigma: predisposition for low adult BMI among people of South Asian descent. Pub Health Nutri 2009;12(04):507–16.
  28. Pineda E, Fitelson D, Rahill J, O'Donnell A, Kuru T, Waldhorn R, Ruse T. Assessing the adjusted neck circumference sleep apnea screening score in patients undergoing polysomnography for suspected sleep apnea. Chest J 2011;140 (4_Meeting Abstracts):812 A-accessed on 5th August 2016 from .
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.