{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:07:44Z","timestamp":1789186064335,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To validate a clinically feasible, multidimensional classification system\u2014SNORES (Severity of apnea\u2013hypopnea index, Nasal airflow limitation, Oxygen desaturation burden, Respiratory effort, Awake Endoscopic anatomy, and Sleep position dependency)\u2014for obstructive sleep apnea (OSA), and to evaluate its ability to predict therapy escalation, CPAP adherence, and surgical intervention beyond the apnea\u2013hypopnea index (AHI) alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective multicenter cohort study, 1560 adults with newly diagnosed OSA confirmed by in\u2010laboratory polysomnography were enrolled. Each SNORES domain was scored from 0 to 3 using predefined objective criteria derived from routine diagnostic testing. Primary outcomes were therapy escalation, CPAP adherence, and surgical intervention. Predictive performance was compared with AHI alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher SNORES scores were independently associated with therapy escalation (hazard ratio [HR] 3.10, 95% CI 2.62\u20133.67;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and surgical intervention (HR 2.71, 95% CI 2.21\u20133.33;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The SNORES framework demonstrated superior discrimination for therapy escalation (area under the curve [AUC] 0.82, 95% CI 0.78\u20130.86) compared with AHI alone (AUC 0.52, 95% CI 0.46\u20130.57; \u0394AUC +0.30,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Removal of individual domains\u2014particularly oxygen desaturation or respiratory effort\u2014meaningfully attenuated predictive performance (\u0394AUC \u22120.09 to \u22120.11).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SNORES is a feasible, reproducible, multidimensional framework that captures clinically relevant heterogeneity in OSA and guides individualized therapy more effectively than traditional AHI\u2010only models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>1.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70549","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T03:51:36Z","timestamp":1775620296000},"page":"4564-4574","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["<scp>SNORES<\/scp>\n                    Classification: Multicenter Prospective Validation for Obstructive Sleep Apnea"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3335-2817","authenticated-orcid":false,"given":"Eishal","family":"Arshad","sequence":"first","affiliation":[{"name":"ENT, Head and Neck Surgery, PESSI Hospital  Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junaid","family":"Iqbal","sequence":"additional","affiliation":[{"name":"ENT, Head and Neck Surgery, PESSI Hospital  Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha","family":"Shafique","sequence":"additional","affiliation":[{"name":"PESSI Hospital  Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199304293281704"},{"issue":"10","key":"e_1_2_9_3_1","first-page":"970","article-title":"Association Between Obstructive Sleep Apnea and Risk of Cardiovascular Disease: A Mendelian Randomization Analysis","volume":"4","author":"Yarmolinsky J.","year":"2019","journal-title":"JAMA Cardiology"},{"key":"e_1_2_9_4_1","first-page":"1","article-title":"Cognitive Consequences of Obstructive Sleep Apnea","volume":"42","author":"Zinchuk A. 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