BackgroundThe STOP-Bang questionnaire is used to screen patients for obstructive sleep apnoea (OSA). We evaluated the association between STOP-Bang scores and the probability of OSA.MethodsAfter Institutional Review Board approval, patients who visited the preoperative clinics for a scheduled inpatient surgery were approached for informed consent. Patients answered STOP questionnaire and underwent either laboratory or portable polysomnography (PSG). PSG recordings were scored manually. The BMI, age, neck circumference, and gender (Bang) were documented. Over 4 yr, 6369 patients were approached and 1312 (20.6%) consented. Of them, 930 completed PSG, and 746 patients with complete data on PSG and STOP-Bang questionnaire were included for data analysis.ResultsThe median age of 746 patients was 60 yr, 49% males, BMI 30 kg m−2, and neck circumference 39 cm. OSA was present in 68.4% with 29.9% mild, 20.5% moderate, and 18.0% severe OSA. For a STOP-Bang score of 5, the odds ratio (OR) for moderate/severe and severe OSA was 4.8 and 10.4, respectively. For STOP-Bang 6, the OR for moderate/severe and severe OSA was 6.3 and 11.6, respectively. For STOP-Bang 7 and 8, the OR for moderate/severe and severe OSA was 6.9 and 14.9, respectively. The predicted probabilities for moderate/severe OSA increased from 0.36 to 0.60 as the STOP-Bang score increased from 3 to 7 and 8.ConclusionsIn the surgical population, a STOP-Bang score of 5–8 identified patients with high probability of moderate/severe OSA. The STOP-Bang score can help the healthcare team to stratify patients for unrecognized OSA, practice perioperative precautions, or triage patients for diagnosis and treatment.

A lthough obstructive sleep apnea (OSA) is common, up to 82% of men and 92% of women with moderate-to-severe sleep apnea have not been diagnosed. The use of preoperative screening instruments may help identify these undiagnosed patients. The STOP-Bang questionnaire has 8 questions and is scored on the basis of yes/no answers. Scores range from a value of 0 to 8, with a score of 3 or greater having a high sensitivity for detecting OSA, 93% and 100% for moderate and severe OSA, respectively. Because the specificity is 47% and 37% for moderate and severe OSA, the false-positive rate of the questionnaire is high. This study was performed to evaluate the predictive probabilities for OSA at different scores on the STOP-Bang questionnaire.Patients older than 18 years undergoing elective procedures were included in the screening process and approached for consent for the preoperative polysomnography (PSG), either portable at home or in the laboratory. All patients were asked to complete the STOP questionnaire. Information on the patient_s body mass index, age, neck circumference, and sex were collected. Manual scoring of PSG was performed according to the Manual of the American Academy of Sleep Medicine. The PSG recordings were scored by a sleep physician. The sleep stages and apnea-hypopnea index (AHI) were scored. The diagnosis of OSA was based on an AHI greater than 5 with fragmented sleep and daytime sleepiness. The severity of OSA with laboratory and portable PSG was classified based on the AHI values: greater than 5 to 15 as mild OSA, greater than 15 to 30 as moderate OSA, and greater than 30 as severe OSA.Over 4 years, 6469 patients were approached, and 1312 consented. Of these, 930 completed PSG, and 746 patients with complete data on PSG and the STOP-Bang questionnaire were included in the final analysis. Their median age was 60 years, 49% were male, body mass index was 30 kg/m 2 , and neck circumference was 39 cm. Of the 746 patients, 510 (68.4%) had OSA, with 287 (38.5%) and 134 (18.0%), respectively, having moderate/severe OSA and severe OSA. Most patients had a STOP-Bang score of 3 and 4 (22.9% and 22.3%, respectively). The area under the receiver operating curves was 0.65, 0.67, and 0.71 for all OSA, moderate/severe OSA, and severe OSA, respectively. For STOP-Bang scores of 5 and 6, the odds ratios (ORs) for moderate/severe OSA were 4.8 and 6.3, respectively, and for severe OSA, 10.4 and 11.6, respectively. For STOPBang scores of 7 and 8, the ORs were 6.9 for moderate/severe OSA and 14.9 for severe OSA. As the STOP-Bang score increased from 3 to 8, sensitivity decreased from 68.4% to 0.4% for patients with moderate/severe OSA and from 94.8% to 0% for those with severe OSA. When the STOP-Bang score was 5, the specificity for moderate/severe and severe OSA was 56.1% and 74.2%, respectively. The probabilities of having OSA were greater and the STOP-Bang score increased, a trend that was the same for the groups of all OSA, moderate/severe OSA, and severe OSA. As the STOP-Bang score increased from 0 to 2 to 7 an...

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