What are effective screening questions for Obstructive Sleep Apnea (OSA)?

From the Guidelines

Good screening questions for obstructive sleep apnea (OSA) should focus on common symptoms and risk factors, with the STOP questionnaire being a recommended tool, consisting of 4 dichotomous questions on snoring, tiredness, observed apnea episodes, and history of high blood pressure, with a score of 2 or higher indicating high risk for OSA. When evaluating patients for OSA, it is essential to ask about symptoms such as loud snoring, witnessed apneas, gasping or choking episodes, excessive daytime sleepiness, and morning headaches, as well as risk factors like obesity, hypertension, and diabetes 1. The STOP-BANG questionnaire is also a useful tool, assigning one point each for: Snoring, Tiredness during the day, Observed apneas, high blood Pressure, BMI over 35, Age over 50, Neck circumference over 40 cm, and male Gender, with a score of 3 or more suggesting increased OSA risk 2.

Some key questions to ask patients include:

• Do you snore loudly or regularly?
• Has anyone observed you stop breathing during sleep?
• Do you experience excessive daytime sleepiness?
• Do you wake up gasping or choking?
• Do you have morning headaches?
• Do you have unrefreshing sleep, difficulty concentrating, or irritability?
• Do you have frequent nighttime urination?
• What is your body mass index (BMI) and neck circumference?
• Do you have a history of hypertension, type 2 diabetes, or heart disease?

These questions are effective because they target the physiological mechanisms of OSA—upper airway collapse during sleep—and its consequences, including sleep fragmentation and intermittent hypoxia that lead to daytime symptoms and associated comorbidities 1, 2. By using these screening questions and tools, healthcare providers can identify patients at high risk for OSA and refer them for further evaluation and treatment, ultimately improving morbidity, mortality, and quality of life outcomes.

From the Research

Screening Questions for Obstructive Sleep Apnea

To identify individuals with obstructive sleep apnea (OSA), several screening questions and tools can be utilized, including:

• The STOP-BANG questionnaire, which is considered the most sensitive screening tool for OSA 3, 4
• The Berlin questionnaire, which has been validated in selected studies 5, 4
• The Epworth Sleepiness Scale (ESS), which assesses daytime sleepiness 5, 4
• The STOP Questionnaire (SQ), which is reliable for screening OSA among sleep clinic patients 4

Identifying High-Risk Individuals

Certain individuals are at higher risk for OSA and may benefit from screening, including:

• Those with resistant or poorly controlled hypertension, pulmonary hypertension, or recurrent atrial fibrillation 6
• Patients with New York Heart Association class II to IV heart failure and suspicion of sleep-disordered breathing or excessive daytime sleepiness 6
• Individuals with nocturnally occurring angina, myocardial infarction, arrhythmias, or appropriate shocks from implanted cardioverter-defibrillators 6
• Patients with excessive daytime fatigue, unrestful sleep, persistent snoring, and nocturnal awakenings with gasping or choking 3

Diagnostic Criteria

The diagnostic standard for OSA is polysomnography with an observed apnea-hypopnea index greater than 5 in the presence of symptoms or greater than 15 without symptoms 3. Home sleep apnea testing is a useful diagnostic option in patients who have symptoms consistent with moderate to severe OSA without significant cardiopulmonary comorbidities 3, 7