From the Guidelines
You should still perform a STOP-BANG assessment for sleep apnea screening even if you are ordering a home sleep study. The STOP-BANG questionnaire is a valuable tool for identifying patients at risk for obstructive sleep apnea (OSA), and its high sensitivity makes it useful for prioritizing patients for sleep studies 1. Although the questionnaire has low specificity, its ease of implementation and high sensitivity make it a useful starting point for comprehensive OSA management 1.
Key Points to Consider
- The STOP-BANG questionnaire evaluates eight key risk factors for OSA, including snoring, tiredness, observed apnea, high blood pressure, BMI, age, neck circumference, and gender 1.
- Patients with intermediate to high scores on the STOP-BANG questionnaire should undergo confirmatory testing, such as polysomnography or home sleep apnea testing 1.
- The questionnaire's simplicity makes it valuable for primary care providers to identify patients needing sleep specialist referrals 1.
- The most recent and highest quality study, from 2024, supports the use of the STOP-BANG questionnaire as a screening tool for OSA, particularly in surgical patients 1.
Clinical Implications
- Healthcare providers should use the STOP-BANG questionnaire during routine assessments, particularly for surgical patients, as undiagnosed OSA increases perioperative complications 1.
- The questionnaire helps prioritize patients for sleep studies, guides perioperative management decisions, and serves as a starting point for comprehensive OSA management, including CPAP therapy, positional therapy, weight management, and surgical interventions when appropriate 1.
From the Research
Role of STOP-BANG Assessment in Sleep Apnea Screening
- The STOP-BANG questionnaire is a validated screening tool for obstructive sleep apnea (OSA) 2, 3.
- It consists of eight dichotomous (yes/no) items related to the clinical features of sleep apnea, with a total score ranging from 0 to 8 3.
- A higher STOP-BANG score is associated with a greater probability of moderate-to-severe OSA 2, 3.
Use of STOP-BANG Assessment in Primary Care Setting
- The STOP-BANG questionnaire can be used as a screening tool to assist in triaging patients with suspected OSA referred to sleep clinics in different global regions 4.
- Implementing a protocol for OSA screening in the primary care setting using the STOP-BANG questionnaire can increase screening and referral rates for sleep studies 5.
- The STOP-BANG screening tool can reliably predict the presence of moderate to severe OSA, and early identification of OSA risks in the primary care setting is crucial to minimize its effects on cardiovascular morbidity and mortality 5.
STOP-BANG Assessment and Home Sleep Study
- The performance of the STOP-BANG questionnaire as a screening tool for diagnosis of OSA in patients undergoing portable monitoring (PM) sleep study has been validated, with higher score thresholds having high specificity and positive predictive value 6.
- However, the false negative rate for unattended portable monitoring sleep study compared to in-lab study was high, suggesting that in-lab sleep study should be performed to rule out OSA in patients with low STOP-BANG scores 6.
- As a primary care physician (PCP) ordering a home sleep study, using the STOP-BANG assessment can help identify patients at high risk for OSA and prioritize those who require further evaluation and treatment 2, 3, 4.