# SnoreLab Application in the Assessment of Obstructive Sleep Apnea Syndrome: A Pilot Study
## 4 Discussion
Indeed, particularly regarding SnoreLab, in comparison to other snore recording apps such as SnoreMonitorSleepLab, Quit Snoring, and Snore Spectrum, the so-called \"Snore Score\" is notably non-transparent. The application does not provide information regarding the methodology used for calculating this score. Consequently, for scientific endeavors, it is considered unnecessary [21]. Although in this study the app was tested in a hospital setting to avoid any recording bias, use at home can be quite different, and many environmental biases can interfere. In fact, other criticisms of SnoreLab and similar apps may arise due to recording interferences caused by the presence of other individuals sleeping nearby the patient [17]. While the app's algorithm can effectively filter out ambient noise and speech, it currently lacks the ability to differentiate between the breathing and snoring of others, presenting a confounding factor. Based on our data, the results do not support the efficacy of SnoreLab in detecting obstructive events. In alignment with the current literature, this suggests the limited reliability of OSAS assessments that lack the integration of snoring recordings with data pertaining to respiratory airflow and thoracoabdominal movements [13; 14]. In fact, Spearman correlation analysis did not reveal a statistically significant correlation between objective measures of PSG, such as AHI and Tc90 (AHI--[PERSON]'s \(\rho\) = 0.145, \(p\) = 0.554; Tc90--[PERSON]'s \(\rho\) = 0.437, \(p\) = 0.07). Additionally, reporting the Snore Score as an average of about 25 may be misleading for patients, posing the risk that many individuals in need of immediate treatment may underestimate the severity of the condition. Moreover, the information section does not adequately explain when to seek medical counseling. In fact, according to SnoreLab's website, _\"A score above 50 puts you in the 'bad snoring' category, and if you're above 100 you definitely need to find some solutions!\"_  
However, as previously mentioned, the cohort exhibited an overall AHI of 15.1 \(\pm\) 17.0, indicative of moderate OSAS, while the average Snore Score reported was 24.8 \(\pm\) 22.2. Additionally, the severe OSA group (AHI 44.9 \(\pm\) 12.0) reached a Snore Score of 35.2 \(\pm\) 21.4, not indicating an advanced snoring category nor the need for immediate medical counseling, according to the app. Conversely, the simple snoring group with AHI <5 reported a Snore Score of 30.7 \(\pm\) 19.2. It is important to note that not all snorers have OSAS and require treatment [22], but there are inadequate explanations about these two conditions in the information provided, and also, how the Snore Score is calculated. Unfortunately, the number of validation studies addressing SnoreLab and snoring apps, in general, is limited. [PERSON] et al. (2021) [7] were pioneers in studying the SnoreLab app beyond a case report level [9], evaluating a cohort of 19 patients undergoing overnight PSG to assess the accuracy of recorded snoring. Similarly, they found that the Snore Score provided by the app averaged 29.1 \(\pm\) 35.2, consistent with median user scores and our findings. However, compared to PSG-measured AHI, all snoring indices showed only a low to moderate correlation (r = 0.495-0.645). Thus, we concur with their conclusion that, while SnoreLab may not be suitable for OSA screening in clinical practice, it could serve as a valuable tool for snoring monitoring alongside different treatment evaluations. While the SnoreLab website disclaims any intention to diagnose OSAS, users may still confuse obstructive apnea events with snoring. Integrating clearer explanations within the app and associated scientific material could mitigate this risk and potentially expedite OSAS diagnosis. Also, it is important to consider that although SnoreLab is a cost-effective solution, additional features such as night recording, trends, and backup require a SnoreLab Premium subscription (EUR 5.99/monthly).