Incorporating body-type (apple vs. pear) in STOP-BANG questionnaire improves its validity to detect OSA

Abstract

Study Objective The aim of this study is to evaluate whether adding the item of “apple body type” to the STOP-BANG questionnaire enhances diagnostic performance of the questionnaire for detecting obstructive sleep apnea (OSA). Design Cross-sectional study Setting Sleep center setting Patients Two hundred and eight subjects who were referred for an evaluation of possible OSA at Tulane Comprehensive Sleep Center. The exclusion criteria were age < 18 years old, incomplete or absent questionnaire, incomplete body type identification, polysomnography (PSG) refusal, and pregnant women. Interventions STOP-BANG items and body type data were collected on the initial clinic visit. An overnight PSG was performed on every participant. Measurements Descriptive analyses of the demographic data and PSG variables were performed. The predictive parameters of STOP and STOP-BANG without and with body type score (STOP-Apple and STOPBANG-Apple) were compared. Main results The STOP questionnaire’s sensitivity/specificity/positive likelihood ratio (+LR) (cut-off = 2) was 96%/11%/1.1, respectively whereas the STOP-Apple questionnaire (cut-off = 3) was 88%/39%/1.5. The STOP-BANG’s sensitivity/specificity/+LR (cut-off = 3) was 96%/19%/1.2, respectively whereas the STOP-BANG-Apple questionnaire (cut-off = 4) was 90%/39%/1.5. The area under the Receiver Operating Characteristic (ROC) curve of STOP-Apple was comparable to the STOP-BANG (P = 0.25). The addition of the apple body type item to the STOP-BANG questionnaire in participants with a score ≥ 3 led to increased specificity (67.4%), increased the odds ratio of having OSA of 2.5 (95% CI, 1.2–5.3) and odds ratio of having moderate-severe OSA of 4.7 (95% CI, 2.5–8.7). Conclusion In the sleep center setting, adding the body type item to the STOP-BANG questionnaire improves not only clinical prediction for PSG confirmed OSA but also predicts moderate to severe of OSA.

Prospective observational investigation of body habitus measurements and relationship to epidural depth in term pregnant women

“…The importance of body shape assessment was the rationale behind this study: various body shapes can be seen for the same BMI, and fat distribution may impact the likelihood of anticipated difficult neuraxial block based on fat distribution. Body shape has been used assist to identify obstructive sleep apnea; apple‐shaped women were more likely to have a high apnea‐hypopnea index associated with a higher STOP‐BANG score . Ethnicity contributes to body shape, for example one study demonstrated that African American women differed significantly in body shape .…”

“…Body shape has been used assist to identify obstructive sleep apnea; apple-shaped women were more likely to have a high apnea-hypopnea index associated with a higher STOP-BANG score. 21 Ethnicity contributes to body shape, for example one study demonstrated that African American women differed significantly in body shape. 9 Sharma reported that ethnicity was related to epidural depth and BMI, possibly related to body shape 9 ; however, the body shapes of the investigated women according to ethnicity were not reported.…”

Pancreatitis: TIGAR-O Version 2 Risk/Etiology Checklist With Topic Reviews, Updates, and Use Primers

“…Visceral adiposity can be estimated by general morphology (e.g., “apple-” or “pear-” shaped obesity, with apple indicating VAT (85,86)), waist circumference, waist-to-hip ratio, computed tomography (CT), magnetic resonance imaging (MRI), or dual-energy x-ray absorptiometry (DXA), and others (84,87). VAT mass measured by DXA is comparable to MRI in a large, multiethnic cohort within a wide range of body fatness (87).…”

Continuous education in procedural sedation: life-threatening airway obstruction and contributing perioperative patient factors

“…The STOP-BANG questionnaire consists of eight-items and has been validated for the screening of patients for obstructive sleep apnoea (OSA). 8 Chung et al concluded that a STOP-BANG score of 5-8 increases the incidence of OSA in the surgical population. 9 OSA is a condition characterised by functional airway collapse during sleep causing reduced or complete cessation of airflow despite ongoing breathing efforts.…”