# NoSAS Score: What Your Result Means

How the NoSAS score screens for sleep apnea from neck size, BMI, snoring, age and sex, what the 8-point cutoff means, and what to do with your score.

Source: https://cpapclarity.com/learn/nosas-score-guide
Published: 2026-10-11
Updated: 2026-10-11
Author: Brian C.

Informational, not medical advice. Talk to your sleep physician before changing your therapy, pressure, mask, or medications.

The NoSAS score is a five-factor sleep apnea screen that adds points for a neck over 40 cm, a BMI of 25 or more, snoring, being older than 55 and being male, for a total from 0 to 17. Its authors found that people scoring 8 or more were more likely to have clinically significant sleep-disordered breathing (Marti-Soler et al., 2016). A score of 8 or more is a reason to talk to your doctor, not a diagnosis. You can [work out your NoSAS score here](https://cpapclarity.com/tools/nosas-score).

## Where the NoSAS Score Came From

The NoSAS score was published in 2016 in *The Lancet Respiratory Medicine* by Marti-Soler, Heinzer and colleagues at Lausanne University Hospital in Switzerland ([abstract on PubMed](https://pubmed.ncbi.nlm.nih.gov/27321086/)). The team wanted a screen simple enough for any clinician to use, because overnight sleep testing is expensive and not available everywhere, so someone has to decide who gets tested first.

They built it from HypnoLaus, a study of the general population of Lausanne. Of its participants, 2,121 adults aged 40 to 85 had both a clinical check-up and a full overnight sleep recording at home, assessed between September 2009 and June 2013. The researchers looked for the smallest set of easily checked facts that picked out the people whose recordings showed clinically significant sleep-disordered breathing, the family of breathing problems during sleep that includes obstructive sleep apnea.

They then checked the score on a second, independent group, the EPISONO cohort in São Paulo, Brazil, a population sample of adults aged 20 to 80. If you are younger than 40 or older than 85, the score was not built from people your age, and the calculator says so. A score that only works on the people it was built from is not much use; testing it somewhere else is how you find out whether it travels.

## How the Points Add Up

The score uses five facts and nothing else. Here is how many points each one adds.

| Factor | When it counts | Points |
|---|---|---|
| Neck circumference | more than 40 cm (about 15.7 in) | 4 |
| Body mass index | 25 to under 30 | 3 |
| Body mass index | 30 or more | 5 |
| Snoring | yes | 2 |
| Age | older than 55 | 4 |
| Sex | male | 2 |

The boundaries are exact. A neck of exactly 40 cm adds nothing; the paper's wording is "more than 40 cm". The same goes for age: 55 adds nothing and 56 adds 4. BMI counts only once, as either 3 or 5 points, so the highest possible total is 4 + 5 + 2 + 4 + 2 = 17.

A total of **8 or more** is at or above the cutoff the authors used to flag a higher chance of clinically significant sleep-disordered breathing. A total of 0 to 7 is below it.

A few worked examples show how quickly the factors combine:

- A 60-year-old man who snores, with a 15-inch neck and a BMI of 24, scores 4 (age) + 2 (male) + 2 (snoring) = **8**, at the cutoff, without any weight or neck points at all.
- A 45-year-old woman who snores, with a BMI of 32 and a 14-inch neck, scores 5 (BMI) + 2 (snoring) = **7**, just under it.
- A 50-year-old man who does not snore, with a 16.5-inch neck (about 41.9 cm) and a BMI of 28, scores 4 (neck) + 3 (BMI) + 2 (male) = **9**.

The [NoSAS calculator](https://cpapclarity.com/tools/nosas-score) shows this breakdown for you, so you can see which factors counted and how far you are from 8.

## How Well Does It Work?

The paper reports how well the score separated people with and without the condition using a measure called the area under the curve (AUC), where 0.5 is a coin toss and 1.0 is perfect. The NoSAS score reached **0.74** in the Swiss group it was built from and **0.81** in the Brazilian validation group.

In the same Swiss data, the authors also scored STOP-Bang (0.67) and the Berlin Questionnaire (0.63), and the NoSAS score did significantly better than both. Two cautions apply to that comparison. It comes from the NoSAS authors' own cohorts, and it is one comparison, not a final ranking. Screening tools often perform differently in different groups, such as a sleep clinic, a surgery pre-assessment clinic or the general public.

What none of these scores can do is diagnose. A screening score estimates who is more likely to have a condition so that testing goes to the right people first. Only an overnight sleep test, read by a clinician, can tell you whether you have sleep apnea and how severe it is.

## What the Score Leaves Out

The NoSAS score gives no points for symptoms. It does not ask whether anyone has seen you stop breathing in your sleep, whether you wake up gasping, or whether you are struggling to stay awake during the day. Those are some of the most important warning signs a doctor asks about.

That design is part of why the score is so quick, but it has a cost. A younger, slimmer person with a small neck can score low and still have sleep apnea, especially if their warning signs are symptoms rather than body measurements. If you have symptoms, mention them to your doctor whatever your score says. Our guide to [sleep apnea signs and symptoms](https://cpapclarity.com/learn/sleep-apnea-symptoms) lists the ones worth bringing up.

The sex factor deserves a word too. The score was built on sex recorded as male or female, and men get 2 points. That is how the score was built from its study data. It does not mean sleep apnea in women is rare or mild, and women's symptoms are often different, as our guide to [sleep apnea in women](https://cpapclarity.com/learn/sleep-apnea-in-women) explains.

## Measuring Your Neck and Working Out BMI

Neck size is worth measuring rather than guessing, because it carries 4 points on its own. Use a soft tape measure around your neck and read it in centimeters or inches. The calculator converts inches to centimeters for you and rounds to one decimal place, and it scores the rounded number it shows you, so what you see is what counted.

For BMI, you can enter your height and weight in feet and pounds or in centimeters and kilograms, or type a BMI you already know. BMI is weight in kilograms divided by height in meters squared. It is a rough measure that does not tell fat from muscle, but it is what the NoSAS score was built on, so it is what the score needs.

## What to Do With Your Score

**If you scored 8 or more,** it is worth discussing with your doctor, who may suggest a sleep test. Many people are now tested at home with a small device worn overnight. Our guides on [how to get tested for sleep apnea](https://cpapclarity.com/learn/how-to-get-tested-for-sleep-apnea) and the [home sleep apnea test](https://cpapclarity.com/learn/home-sleep-test-guide) explain what that involves.

**If you scored under 8** but you have symptoms (loud snoring, breathing pauses someone has noticed, waking up gasping, heavy daytime sleepiness), still mention them. A low screening score does not rule sleep apnea out.

**If you did not know whether you snore,** the calculator shows your score both ways. Snoring is worth 2 points, which can be the difference between 7 and 9, so it is worth asking someone who has heard you sleep.

Bring the breakdown to your appointment. "My NoSAS score is 9, from a neck over 40 cm, a BMI of 28 and being male" gives your doctor more to work with than "I think I might have sleep apnea."

## When to Talk to Your Doctor

Talk to your doctor promptly if you have nodded off while driving, if someone has seen you stop breathing during sleep, or if you wake up choking or gasping. Those warrant a conversation regardless of any score. A score of 8 or more on its own is also a good reason to ask about testing.

## If You Already Use CPAP

The NoSAS score is a pre-diagnosis screen. If you are already diagnosed and using CPAP, it has little to tell you. Your machine records how your therapy is going every night. You can import your SD card into [CPAP Clarity](https://cpapclarity.com/) to see your AHI, leak and usage in your browser, and bring that to your sleep physician instead.

## Frequently Asked Questions

### What is a normal NoSAS score?

The score runs from 0 to 17. The authors used 8 points or more as the cutoff for a higher chance of clinically significant sleep-disordered breathing, so 0 to 7 is below the cutoff and 8 to 17 is at or above it. A score under 8 does not rule sleep apnea out.

### How many points does a large neck add to the NoSAS score?

A neck circumference of more than 40 cm adds 4 points. Exactly 40 cm adds nothing.

### Is the NoSAS score better than STOP-Bang?

In the 2016 paper that introduced it, the NoSAS score separated people with and without the condition better than STOP-Bang and the Berlin Questionnaire in the authors' Swiss cohort (0.74 against 0.67 and 0.63). That is one comparison from the authors' own data, not a final ranking.

### Does a NoSAS score of 8 or more mean I have sleep apnea?

No. It means the score puts you in the group the authors found more likely to have clinically significant sleep-disordered breathing. Only an overnight sleep test, read by a clinician, can diagnose sleep apnea. It is worth discussing with your doctor.

## Primary Sources

- Marti-Soler H, Hirotsu C, Marques-Vidal P, et al. The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. *Lancet Respir Med*. 2016;4(9):742-748. [PubMed](https://pubmed.ncbi.nlm.nih.gov/27321086/)