ORIGINAL RESEARCH article
Front. Med.
Sec. Pulmonary Medicine
NoSAS Score and the 5-Year Risk of Incident Cerebrovascular Disease: A Retrospective Cohort Study
Provisionally accepted
Huimin ChenXiaomi ChenJunqi Ren
Shuyeu ZhouHuan Li
Zhaojun Chen
Yihuan Su
Dongjie HuangSiyu HeXinyao Liu
Sun TingtingQinghua Chen
Enlin Ye
Junfen ChengBaozhi Zhang
Riken Chen*Lijuan Zeng*
Yuli Cai*- The Second Affiliated Hospital of Guangdong Medical University, zhanjiang, China
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Objectives Obstructive sleep apnea (OSA) is a common but often underdiagnosed disorder linked to various adverse health outcomes, especially cerebrovascular events. This study aims to evaluate the utility of the NoSAS score in screening for high risk of cerebrovascular disease, facilitating early identification and improving clinical management of OSA in susceptible populations. Methods This retrospective study enrolled patients from two sleep centers who underwent sleep apnea monitoring between September 2016 and December 2019. Individuals with pre-existing cerebrovascular disease were excluded from the study . Follow-up data on 5-year incident cerebrovascular events were collected via medical records or telephone interviews. Cerebrovascular events were primarily identified based on patient self-report and available clinical documentation; systematic neuroimaging confirmation was not routinely available. Participants were categorized by NoSAS score into high-risk (≥8) and low-risk (<8) groups. Logistic regression was used to assess the association between NoSAS risk classification and cerebrovascular disease incidence, and Nelson-Aalen were used to compare compared cumulative risk between groups over the 5-year period. Result A total of 1348 participants with complete NoSAS score data who completed follow-up were included in the analysis. Among the 690 participants in the high-risk group, the 5-year incidence of cerebrovascular disease was 9.71%. In the adjusted model, the NoSAS high-risk group had a 1.8-fold increased risk of cerebrovascular disease compared to the low-risk group (OR: 1.85,95% CI: 1.01~ 3.38; p=0.045). ESS-stratified analyses showed significant associations between NoSAS risk classifications and cerebrovascular disease in ESS scores ≤9 . Conclusion The NoSAS high-risk group showed a higher incidence of cerebrovascular disease, which could be used as an independent predictor of the disease and may have higher predictive value in the high-risk group of non-sleepy OSA.
Keywords: A retrospective cohort study, cerebrovascular disease, NoSAS questionnaire, Obstructive sleep apnoea (OSA), Prevalence
Received: 29 Nov 2025; Accepted: 02 Feb 2026.
Copyright: © 2026 Chen, Chen, Ren, Zhou, Li, Chen, Su, Huang, He, Liu, Tingting, Chen, Ye, Cheng, Zhang, Chen, Zeng and Cai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Riken Chen
Lijuan Zeng
Yuli Cai
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