Most individual symptoms and signs have limited utility in determining the likelihood of OSA, and no one sign is sufficiently precise to rule in or rule out this condition. Although the absence of snoring makes a diagnosis of OSA less likely, snoring on its own is common and does not discriminate between those with and without OSA. Thus, snoring must be interpreted in the context of other symptoms and signs. Likewise, self-reported sleepinessandmorning headaches do not help discriminate among patients with and without OSA. It is somewhat surprising that the overall impression of sleep medicine physicians of the likelihood of OSA in individual patients does not perform much better than the limited utility of individual findings. It is important to recognize that persons with normal body weight who do not snore are unlikely to have OSA, and their complaints of daytime sleepiness or fatigue should prompt an evaluation for alternative diagnoses.
Although the evidence shows that a number of recently published multi-itemed questionnaires may help rule out OSA, they are not helpful in identifying patients affected by sleep apnea. Fortunately, it appears that an explicit combination of only a few findings, expressed as the SACS, has promise for identifying patients most likely to have OSA. Although the test is seemingly easy to use, validation at current diagnostic thresholds in more general populations by primary care clinicians would provide important evidence to justify its use in routine screening.