From the Guidelines
The STOPBANG questionnaire should be used as a screening tool for obstructive sleep apnea (OSA) due to its high sensitivity, but not as a diagnostic instrument due to its low specificity, as evidenced by a 2017 clinical practice guideline from the American Academy of Sleep Medicine 1. The STOPBANG questionnaire is a validated screening tool that assigns one point for each of eight risk factors, with a total score ranging from 0-8. The components are: Snoring, Tiredness, Observed apnea, high blood Pressure, BMI greater than 35 kg/m², Age over 50 years, Neck circumference greater than 40 cm, and male Gender. Scoring interpretation is as follows:
- 0-2 points indicates low risk for OSA
- 3-4 points suggests intermediate risk
- 5-8 points indicates high risk The higher the score, the greater the likelihood of moderate to severe OSA. This tool is particularly useful in preoperative settings to identify patients who may need further sleep evaluation before surgery, as undiagnosed OSA increases perioperative risks. For patients with high scores, referral for formal sleep studies, such as polysomnography (PSG), should be considered, especially before elective surgery, as the STOP-BANG questionnaire had high sensitivity, but low specificity for the detection of OSA, with more pronounced findings when higher levels of OSA category cutoffs were considered 1.
From the Research
STOPBANG Scoring Overview
- The STOPBANG questionnaire is a screening tool used to identify patients at high-risk of obstructive sleep apnea (OSA) 2.
- A STOPBANG score of 0-2 indicates low-risk for moderate-to-severe OSA, while a score of 5-8 indicates high-risk 2.
- Patients with a score of 3 or 4 are considered high-risk if they have a specific combination of factors, such as a STOP score of at least 2 + BMI more than 35 kg/m or STOP score at least 2 + male or STOP score at least 2 + neck circumference more than 40 cm 2.
Predicting OSA Severity
- The STOPBANG score correlates with the apnea hypopnea index (AHI) and is useful for predicting OSA severity 3.
- A STOPBANG score of 5 or higher has a sensitivity of 80.0% and specificity of 76.9% for detecting severe OSA 3.
- A STOPBANG score of 5 or higher, combined with a BMI of 30 kg/m2 or higher, is an independent risk factor for severe OSA 3.
Clinical Applications
- The STOPBANG questionnaire can be used as a novel tool for perioperative risk stratification to identify patients at increased risk of perioperative complications 2.
- A stepwise stratification approach is recommended to reduce false positive cases and improve the specificity of the STOPBANG questionnaire 2.
- Polysomnography should be performed actively for patients with high STOPBANG scores to confirm the diagnosis of OSA 3.