What Defines a Positive STOP-BANG Score
A STOP-BANG score of ≥3 is considered positive and indicates intermediate to high risk for obstructive sleep apnea, warranting further diagnostic testing with polysomnography or home sleep apnea testing. 1
Understanding the STOP-BANG Scoring System
The STOP-BANG questionnaire consists of eight dichotomous (yes/no) items, with each positive response contributing one point to create a total score ranging from 0 to 8. 1, 2 The eight components assess:
- Snoring
- Tiredness/fatigue during daytime
- Observed apnea during sleep
- High blood Pressure
- BMI >35 kg/m²
- Age >50 years
- Neck circumference (>40 cm in men, >38 cm in women)
- Male Gender 1
Risk Stratification Based on Score
Low Risk (Score 0-2): These patients have low probability of moderate to severe OSA, with only 18% probability of moderate to severe OSA and 4% probability of severe OSA. 2
Intermediate Risk (Score 3-4): A score of 3 demonstrates high sensitivity (93% for moderate to severe OSA, 100% for severe OSA) but moderate specificity for detecting OSA. 1, 2 These patients require further diagnostic testing as the score alone cannot definitively diagnose OSA. 1
High Risk (Score 5-8): As scores increase from 5 to 8, the probability of moderate to severe OSA rises to 60%, and severe OSA probability increases to 38%. 2
Clinical Action Required for Positive Scores
For scores ≥3, the American College of Physicians recommends further diagnostic testing because screening tools alone cannot definitively diagnose OSA. 1 The diagnostic pathway includes:
- Home sleep apnea testing (HSAT) for patients with high pretest probability 1
- In-laboratory polysomnography (PSG) remains the gold standard for diagnosis 1
Important Clinical Caveats
Do not rely solely on the STOP-BANG score for diagnosis without confirmatory testing. 1 The questionnaire has high sensitivity but low specificity, leading to potential false positives. 1, 3 In sleep laboratory settings, specificity ranges from only 33-48% depending on OSA severity. 3
The negative predictive value is the tool's strength: A STOP-BANG score ≥3 has negative predictive values of 90% for moderate to severe OSA and 100% for severe OSA, meaning negative results (scores <3) effectively help identify individuals unlikely to have significant apnea. 2
Population-specific limitations exist: The STOP-BANG was primarily validated in middle-aged, predominantly male populations, which may affect accuracy in other demographics such as adolescent females. 4