High STOP-Bang Score Indicates a High Probability of Obstructive Sleep Apnoea

Abstract

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...

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

“…There is strong evidence to support a high predictive value of the STOP-BANG questionnaire for preoperative screening of OSA [206]. Patients with moderate to high risk should be considered for positive airway pressure support postoperatively.…”

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

“…Screening tools such as the 8-item STOP-Bang questionnaire (Appendix 1) 45 can effectively identify at-risk patients and allow coordination of care with a sleep medicine specialist. 46 Careful planning is necessary rhinoplasty is performed among patients with severe OSA, due to the higher risk of complications intraoperatively (eg, intubation, pulmonary care, safe recovery) and postoperatively. Nevertheless, rhinoplasty and related procedures are performed among selected severe OSA patients to improve compliance with established treatments such as CPAP.…”

The importance of obstructive sleep apnoea management in peri-operative medicine

“…Different screening questionnaires have been used, but most are subjective and the answers are influenced by the individual's motivation. The STOP-Bang questionnaire aims to reduce the subjectivity of patient responses and is gaining popularity [32][33][34]. It is a selfadministered screening tool and includes four 'yes/no' questions with a mnemonic (S-snoring, Ttiredness, O-observed you stop breathing, P-blood pressure) in addition to demographic data including body mass index (> 35 kg.m À2 ), age (> 50 years), neck circumference (> 40 cm) and gender (male) (see www.stopbang.ca).…”