Validation of the STOP-Bang questionnaire as a preoperative screening tool for obstructive sleep apnea: a systematic review and meta-analysis

Abstract

Background Obstructive sleep apnea (OSA) is a common disorder that is highly associated with postoperative complications. The STOP-Bang questionnaire is a simple screening tool for OSA. The objective of this systematic review and meta-analysis is to evaluate the validity of the STOP-Bang questionnaire for screening OSA in the surgical population cohort. Methods A systematic search of the following databases was performed from 2008 to May 2021: MEDLINE, Medline-in-process, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Journals @ Ovid, Web of Science, Scopus, and CINAHL. Continued literature surveillance was performed through October 2021. Results The systematic search identified 4641 articles, from which 10 studies with 3247 surgical participants were included in the final analysis. The mean age was 57.3 ± 15.2 years, and the mean BMI was 32.5 ± 10.1 kg/m2 with 47.4% male. The prevalence of all, moderate-to-severe, and severe OSA were 65.2, 37.7, and 17.0%, respectively. The pooled sensitivity of the STOP-Bang questionnaire for all, moderate-to-severe, and severe OSA was 85, 88, and 90%, and the pooled specificities were 47, 29, and 27%, respectively. The area under the curve for all, moderate-to-severe, and severe OSA was 0.84, 0.67, and 0.63. Conclusions In the preoperative setting, the STOP-Bang questionnaire is a valid screening tool to detect OSA in patients undergoing surgery, with a high sensitivity and a high discriminative power to reasonably exclude severe OSA with a negative predictive value of 93.2%. Trial registration PROSPERO registration CRD42021260451.

Sleep Subdomain of the Sinonasal Outcome Test as a Potential Screening Tool for Sleep Apnea in Chronic Rhinosinusitis

“…The gold standard for obtaining a diagnosis of OSA is polysomnography (PSG), but this is costly and burdensome 3,22 . Alternatively, three validated OSA screening tools are available including the STOP‐BANG, which consists of eight yes‐no questions and has a sensitivity of 92.9% for detecting moderate–severe OSA 2,16 . A recent meta‐analysis has determined that a positive STOP‐BANG screen may serve as an acceptable alternative to PSG 22 .…”

“…3,22 Alternatively, three validated OSA screening tools are available including the STOP-BANG, which consists of eight yes-no questions and has a sensitivity of 92.9% for detecting moderate-severe OSA. 2,16 A recent meta-analysis has determined that a positive STOP-BANG screen may serve as an acceptable alternative to PSG. 22 However, the use of screening tools for OSA adds time to patient encounters and therefore may deter regular use.…”

“…Although the perioperative risks of OSA are well‐known, less than 20% of Rhinology and Skull Base surgeons perform preoperative screening 15 . Multiple validated tools with high sensitivity for detection of moderate‐to‐severe OSA are available for in‐office administration, including the eight‐question STOP‐BANG questionnaire, which has also been validated as a screening tool in surgical populations 2,16 . The Sinonasal Outcome Test Questionnaire (SNOT‐22) is commonly employed by sinus surgeons to monitor CRS‐related outcomes and QOL, and includes a sleep disturbance subdomain, herein referred to as the “Sleep‐SNOT” 1,13 .…”

“…), Thomas Jefferson University Hospital, Philadelphia, which has also been validated as a screening tool in surgical populations. 2,16 The Sinonasal Outcome Test Questionnaire (SNOT-22) is commonly employed by sinus surgeons to monitor CRS-related outcomes and QOL, and includes a sleep disturbance subdomain, herein referred to as the "Sleep-SNOT". 1,13 This study compares Sleep-SNOT and STOP-BANG scores in CRS patients with and without OSA undergoing endoscopic sinus surgery (ESS).…”

Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions

“…In the preoperative setting, the STOP-Bang tool has shown a sensitivity of detecting all, moderate-to-severe, and severe OSA of 85%, 88%, and 90% respectively. This comes with a low specificity of 47%, 29% and 27% for each severity category [51]. It has been validated amongst different patient groups [50 ▪ ] and across different geographical regions [52 ▪ ], although notably shows worse performance in East Asia compared to other parts of the world.…”