Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population

We aim to assess the utility of a simple-to-use 8-point questionnaire in screening for moderate-severe obstructive sleep apnea (OSA) and to assess the validity of cutoffs used to score body mass index (BMI) in this questionnaire.

Patients undergoing diagnostic polysomnography (PSG) were asked to fill in a questionnaire with a simple dichotomized 8-point questionnaire, represented by the mnemonic STOP-BANG. A score of 3 or more out of a possible 8 was taken to indicate high risk for presence of OSA. These were then evaluated versus results from the overnight, monitored PSG.

Three hundred and forty-eight patients underwent overnight diagnostic PSG, of whom 319 (91.2%) completed the questionnaire. Seventy-four (22.7%) were classified as being at low risk of OSA and 252 (77.3%) were classified as being high risk. The sensitivities of the STOP-BANG screening tool for an AHI of >5, >15, and >30 were 86.1%, 92.8%, and 95.6%, respectively, with negative predictive values of 84.5% and 93.4% for moderate and severe OSA, respectively. Using cutoffs of 30 or 35 for scoring the BMI did not significantly change the performance of the screening tool.

STOP-BANG is a clinically useful tool with high sensitivity that can be used to screen patients for moderate and severe OSA. Using cutoffs of 30 for BMI, 40 cm for neck circumference, and 50 years for age simplifies the application of the tool without affecting performance.