Validation of the STOP-Bang questionnaire as a means of screening for obstructive sleep apnea in adults in Brazil

Abstract

Objective:To validate the Portuguese-language version of the STOP-Bang (acronym for Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) questionnaire, culturally adapted for use in Brazil, as a means of screening for obstructive sleep apnea (OSA) in adults. Methods:In this validation study, we enrolled patients ≥ 18 years of age, recruited between May of 2015 and November of 2016. All patients completed the STOP-Bang questionnaire and underwent overnight polysomnography. To evaluate the performance of the questionnaire, we used contingency tables and areas under the (receiver operating characteristic) curve (AUCs). Results:We included 456 patients. The mean age was 43.7 ± 12.5 years, and 291 (63.8%) of the patients were male. On the basis of the apnea-hypopnea index (AHI), we categorized OSA as mild/moderate/severe (any OSA; AHI ≥ 5 events/h), moderate/severe (AHI ≥ 15 events/h), or severe (AHI ≥ 30 events/h). The overall prevalence of OSA was 78.3%, compared with 52.0%, and 28.5% for moderate/severe and severe OSA, respectively. The most common score on the STOP-Bang questionnaire was 4 points (n = 106), followed by 3 points (n = 85) and 5 points (n = 82). An increase in the score was paralleled by a reduction in sensitivity with a corresponding increase in specificity for all AHI cut-off points. The AUCs obtained for the identification of any, moderate/severe, and severe OSA were: 0.743, 0.731, and 0.779, respectively. For any OSA, the score on the questionnaire (cut-off, ≥ 3 points) presented sensitivity, specificity, and accuracy of 83.5%, 45.5%, and 75.2%, respectively. Conclusions:The STOP-Bang questionnaire performed adequately for OSA screening, indicating that it could be used as an effective screening tool for the disorder.

Cutoff points in STOP-Bang questionnaire for obstructive sleep apnea

“…The STOP-Bang instrument presented different versions developed in order to try to improve the diagnosis of OSAS and to discriminate the subgroups with mild, moderate and severe OSAS, in addition to adapting it to constitutional anatomical differences of patients from other countries 5,8,10,11,22.29 . There is another validated version for the Portuguese language spoken in Brazil, which incorporates different values of cervical circumference (greater than 43 cm for men and 41 cm for women), with final scores ranging from low and moderate to high risk of OSAS; this version had a slightly higher sensitivity (83.5%) for the Brazilian sample, but a much lower specificity (45.5%) than the version used for us 31,32 . Thus, our proposal of different cutoff points for OSAS in general, and for the mild, moderate and severe subtypes, could improve the performance of the instrument in our population.…”

Real-World Data in Support of Short Sleep Duration with Poor Glycemic Control, in People with Type 2 Diabetes Mellitus

“…Participants were divided into three categories according to SD: short sleep (<6 hours/24 hours), intermediate sleep (6-8 hours/24 hours), and long sleep (>8 hours/24 hours). The risk of OSA, a potential confounder of the relationship between SD and GC, was determined by the Brazilian version of the STOP-BANG questionnaire [27] (score ≥ 3 used as a risk indicator). Excessive daytime somnolence (EDS) was evaluated by the Brazilian version of the Epworth Sleepiness Scale [28] (score > 10 identified EDS).…”

Performance of instruments aimed at detecting obstructive sleep apnea syndrome among individuals in Chile

“…In the present study, the STOP-Bang questionnaire showed the best performance in a population at risk for OSAS, similar to what was reported in a study conducted in Brazil. 9 In a systematic review and meta-analysis, a STOP-Bang cutoff score ≥ 3 had an AUC of 0.72 (with a sensitivity and specificity of 90% and 49%, respectively) for predicting an AHI ≥ 5 events/h. 10 For predicting an AHI ≥ 30 events/h, the authors found the sensitivity and specificity of that same cut-off score to be 96% and 25%, respectively.…”

“…In our validation cohort (private clinic group), contingency tables showed that those cut-off points still had the best sensitivity and specificity for Performance of instruments aimed at detecting obstructive sleep apnea syndrome among individuals in Chile In the present study, the STOP-Bang questionnaire showed the best performance in a population at risk for OSAS, similar to what was reported in a study conducted in Brazil. (9) In a systematic review and meta-analysis, a STOP-Bang cutoff score ≥ 3 had an AUC of 0.72 (with a sensitivity and specificity of 90% and 49%, respectively) for predicting an AHI ≥ 5 events/h. (10) For predicting an AHI ≥ 30 events/h, the authors found the sensitivity and specificity of that same cut-off score to be 96% and 25%, respectively.…”