Association between cardiovascular mortality and STOP-Bang questionnaire scores in a cohort of hospitalized patients: a prospective study

Abstract

Objective: Obstructive sleep apnea (OSA) is associated with an increased risk of mortality and cardiometabolic diseases. The STOP-Bang questionnaire is a tool to screen populations at risk of OSA and prioritize complementary studies. Our objective was to evaluate the clinical utility of this questionnaire in identifying patients at an increased risk of mortality after discharge in a cohort of hospitalized patients. Methods: This was a prospective cohort study involving consecutive patients admitted to an internal medicine unit between May and June of 2017 who were reevaluated three years after discharge. At baseline, we collected data on comorbidities (hypertension, obesity, diabetes, and fasting lipid profile) and calculated STOP-Bang scores, defining the risk of OSA (0-2 score, no risk; = 3 score, risk of OSA; and = 5 score, risk of moderate-to-severe OSA), which determined the study groups. We also recorded data regarding all-cause and cardiovascular mortality at the end of the follow-up period. Results: The sample comprised 435 patients. Of those, 352 (80.9%) and 182 (41.8%) had STOP-Bang scores = 3 and = 5, respectively. When compared with the group with STOP-Bang scores of 0-2, the two groups showed higher prevalences of obesity, hypertension, diabetes, and dyslipidemia. Multivariate analysis showed an independent association between cardiovascular mortality and STOP-Bang score = 5 (adjusted hazard ratio = 3.12 [95% CI, 1.39-7.03]; p = 0.01). Additionally, previous coronary heart disease was also associated with cardiovascular mortality. Conclusions: In this cohort of hospitalized patients, STOP-Bang scores = 5 were able to identify patients at an increased risk of cardiovascular mortality three years after discharge.

Associations of Chronic Diabetes Complications and Cardiovascular Risk with the Risk of Obstructive Sleep Apnea in Patients with Type 2 Diabetes

“…We compared 10-year cardiovascular risk in patients with T2DM according to the STOP-Bang score. Similar to our study, other studies have shown that the STOP-Bang score can be used to identify patients at risk of developing fatal or nonfatal CHD as well as fatal or nonfatal stroke [ 17 , 18 , 35 ]. In a recent prospective study that enrolled 435 patients, it was demonstrated that a STOP-Bang score ≥5 was associated with increased all-cause mortality and cardiovascular mortality over 36 months follow-up (95 patients died, 34 of them due to cardiovascular events), with a hazard ratio of 3.12 [ 18 ].…”

“…Similar to our study, other studies have shown that the STOP-Bang score can be used to identify patients at risk of developing fatal or nonfatal CHD as well as fatal or nonfatal stroke [ 17 , 18 , 35 ]. In a recent prospective study that enrolled 435 patients, it was demonstrated that a STOP-Bang score ≥5 was associated with increased all-cause mortality and cardiovascular mortality over 36 months follow-up (95 patients died, 34 of them due to cardiovascular events), with a hazard ratio of 3.12 [ 18 ]. Furthermore, the same authors demonstrated in an observational study from 2019 that altered STOP-Bang score is associated with an increased cardiovascular risk assessed using the American Heart Association cardiovascular risk calculator [ 36 ].…”

“…As presented in Figure 1 , 553 answered the STOP-Bang questionnaire, 529 having complete data were enrolled in the study. According to the results obtained from the STOP-Bang questionnaire, the study subjects were divided into 2 groups, as follows: Group 1—217 patients with STOP-Bang score <5; Group 2—312 patients with STOP-Bang score ≥5 (patients with moderate-to-severe OSA risk [ 18 ]). …”

“…The answer “yes” to each question was scored 1. The moderate-to-severe OSA risk was defined if STOP-Bang score was ≥5 [ 18 ].…”

“…Moreover, a meta-analysis including data from 1894 patients demonstrated that the STOP-Bang questionnaire is an effective tool for OSA screening in patients with cardiovascular risk factors [ 17 ]. The sensitivity of the STOP-Bang questionnaire is 90% for the identification of OSA risk when using a cut-off of ≥3, while the use of a cut-off of ≥5, increases the sensitivity to identify the subjects at risk of moderate-to-severe OSA, but at the cost of a decreased specificity [ 18 ]. Furthermore, in a recent prospective study [ 18 ] it was concluded that STOP-Bang scores ≥5 were associated with high cardiovascular mortality within three years follow-up.…”