From the Guidelines
The STOP-BANG score is a valuable screening tool for assessing the risk of obstructive sleep apnea (OSA) and should be used to stratify the risk of OSA in patients who report sleep complaints. The STOP-BANG score consists of eight yes/no questions, with each "yes" answer contributing one point to the total score, and a score of 0-2 indicates low risk for OSA, 3-4 suggests intermediate risk, and 5-8 points to high risk 1. This simple questionnaire is particularly valuable in preoperative settings where undiagnosed OSA can increase perioperative complications. The effectiveness of the STOP-BANG score comes from its inclusion of both subjective symptoms (the STOP portion) and objective physical characteristics (the BANG portion), making it more comprehensive than symptom-based screening alone.
Key Points to Consider
- The STOP-BANG score has a sensitivity of 0.90 (95% CI: 0.90 to 0.95) and specificity of 0.36 (95% CI: 0.29 to 0.44) for diagnosing OSA 1.
- The quality of evidence for the use of the STOP-BANG questionnaire ranged from low to high across different AHI cutoffs, but the overall quality of evidence across AHI cutoffs was moderate 1.
- The VA/DOD CPG suggests using the STOP questionnaire to stratify the risk of OSA in patients who report sleep complaints, and assessing for sleep-disordered breathing in patients with a history of cardiovascular or cerebrovascular events, congestive heart, and chronic prescription opioid use 1.
Clinical Application
The STOP-BANG score can be used in clinical practice to identify patients who may need further sleep testing, such as polysomnography, to confirm an OSA diagnosis. Healthcare providers should use the STOP-BANG score to assess the risk of OSA in patients who report sleep complaints, and consider further testing and treatment options based on the patient's risk level. Additionally, the STOP-BANG score can be used to monitor the effectiveness of treatment and adjust treatment plans as needed.
Limitations and Future Directions
While the STOP-BANG score is a valuable screening tool, it has limitations, including a relatively low specificity and the potential for false negatives. Further research is needed to improve the accuracy and effectiveness of the STOP-BANG score, and to develop new screening tools and treatment options for OSA. Additionally, the STOP-BANG score should be used in conjunction with other diagnostic tools and clinical judgment to ensure accurate diagnosis and effective treatment of OSA.
From the Research
Overview of the STOP-Bang Score
- The STOP-Bang score is a screening tool used to assess the risk of obstructive sleep apnea (OSA) 2, 3, 4, 5, 6.
- It consists of eight dichotomous (yes/no) items related to the clinical features of sleep apnea, including snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and male gender 2.
- The total score ranges from 0 to 8, with higher scores indicating a higher risk of OSA 2, 3, 4, 5, 6.
Interpretation of the STOP-Bang Score
- A STOP-Bang score of 0 to 2 indicates a low risk of moderate to severe OSA, while a score of 5 to 8 indicates a high risk 2, 3, 5.
- A score of 3 or 4 requires further evaluation to determine the risk of OSA 2.
- The sensitivity of a STOP-Bang score ≥ 3 to detect moderate to severe OSA is 93%, and the negative predictive value is 90% 2.
- The probability of moderate to severe OSA increases with increasing STOP-Bang scores, from 18% for a score of 0 to 2 to 60% for a score of 7 to 8 2.
Validation of the STOP-Bang Score
- The STOP-Bang score has been validated as a screening tool for OSA in various populations, including sleep clinic and surgical populations 3, 4, 5.
- The score has been shown to have high sensitivity and specificity for detecting OSA, particularly in patients with a high risk of OSA 3, 4, 5, 6.
- The STOP-Bang score correlates with the apnea-hypopnea index (AHI), a measure of OSA severity, and can be used to predict the severity of OSA 6.