Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnoea in patients with cardiovascular risk factors: a systematic review and meta-analysis

Abstract

IntroductionObstructive sleep apnoea (OSA) is highly prevalent in patients with cardiovascular risk factors and is associated with increased morbidity and mortality. This review presents the predictive parameters of the STOP-Bang questionnaire as a screening tool for OSA in this population.MethodsA search of databases was performed. The inclusion criteria were: (1) use of the STOP-Bang questionnaire to screen for OSA in adults (>18 years) with cardiovascular risk factors; (2) polysomnography or home sleep apnoea testing performed as a reference standard; (3) OSA defined by either Apnoea–Hypopnoea Index (AHI) or Respiratory Disturbance Index; and (4) data on predictive parameters of the STOP-Bang questionnaire. A random-effects model was used to obtain pooled predictive parameters of the STOP-Bang questionnaire.ResultsThe literature search resulted in 3888 articles, of which 9 papers met the inclusion criteria, involving 1894 patients. The average age of the included patients was 58±13 years with body mass index (BMI) of 30±6 kg/m2, and 64% were male. The STOP-Bang questionnaire has a sensitivity of 89.1%, 90.7% and 93.9% to screen for all (AHI ≥5), moderate-to-severe (AHI ≥15) and severe (AHI≥30) OSA, respectively. The specificity was 32.3%, 22.5% and 18.3% and the area under the curve (AUC) was 0.86, 0.65 and 0.52 for all, moderate-to-severe and severe OSA, respectively.ConclusionThe STOP-Bang questionnaire is an effective tool to screen for OSA (AHI≥5) with AUC of 0.86 in patients with cardiovascular risk factors.

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 ].…”

“…In a study from 2008, Chung et al [ 47 ] proved that STOP-Bang score has a sensitivity of 100% for AHI ≥ 30; however, the small specificity of 37.0% means that there are also many false positive cases reported, suggesting that even though the STOP-Bang questionnaire is a very quick and easy tool to apply for the screening of OSA, in order to properly diagnose and treat this category of patients they should be referred for polysomnography or home sleep apnea testing (HSAT), as is recommended by the American Academy of Sleep Medicine (AASM) [ 48 ]. However, many patients unfortunately refuse undergoing such expensive investigations, and in these conditions, undiagnosed cases can significantly increase the burden on the public health system and also decrease the quality of life of patients, thus necessitating the acceptance of a screening method with high sensitivity, even at the cost of low specificity, such as the STOP-Bang questionnaire [ 17 ].…”

“…Over time, numerous studies have established a close association between OSA and cardiovascular diseases (stroke, hypertension, HF, FiA, cerebrovascular disease, CHD) [ 17 , 49 , 50 ]. Epidemiological studies have shown that obesity increases the risk of developing both cardiovascular and metabolic disorders.…”

“…Two studies conducted in Asian [ 15 ] and Caucasian [ 16 ] patients with T2DM also proved the utility of the STOP-Bang score in this group of patients. 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 ].…”

The Value of Nurse-led Anthropometric and Oropharyngeal Measurements Combined with STOP-Bang Questionnaire in Screening for Obstructive Sleep Apnea in Patients with Acute Coronary Syndrome: A Prospective Cohort Study

“…showed that the SBQ could be an effective tool for screening OSA (AHI ≥ 5) in patients with cardiovascular risk factors [20]. Although the SBQ has been validated in different populations, there may still be potential biases in some validation studies due to the possible self-selection bias of patients themselves [11].…”