Utility of the STOP-BANG components to identify sleep apnea using home respiratory polygraphy

Utility of questionnaires to estimate the probability of obstructive sleep apneas (OSA) is varying, and it is challenging to know the performance of STOP (Snore, Tired, Observed apnea, and Pressure)-BANG (BMI, Age, Neck and Gender) with simplified methods. To assess the performance of STOP-BANG and its ability to predict sleep apnea in patients with high pre-test like-hood to present OSA referred for a home respiratory polygraphy (RP) were studied.

A cross-sectional study of patients recruited over 26 months was performed. They were asked to complete the STOP-BANG questionnaire during evaluation prior to RP and were evaluated according to different apnea-hypopnea index (AHI) cut-offs. Areas under receiver operating characteristic (ROC) curves and multiple logistic regression models were calculated.

Eight hundred sixty-nine patients were studied; 557 were male (64.1 %) with a median age of 52.82 ± 14.43 years, a body mass index (BMI) of 32.88 ± 8.51, and Epworth Sleepiness Scale (ESS) score of 7.95 ± 5.17. The performance for AHI ≥5/h (ROC area) was: STOP 0.62, BANG 0.66, and STOP-BANG 0.69. The best sensitivity (S)-specificity (Sp) relationship for AHI ≥5/h was found with 5 components in any combination (S 56.02 %; Sp 70 %). For AHI ≥30/h, STOP was 0.68, BANG 0.66 and STOP-BANG 0.73 and the best S-Sp relationship was obtained with 5 components (S 68 %; Sp 63.6 %). Six variables (snoring, observed apneas, high blood pressure (HBP), BMI >35, neck perimeter >40 cm, and male gender) showed the best performance for AHI >30/h; ROC area 0.76.

STOP-BANG shows different discrimination power for AHI >5 and ≥30/h using RP. Five components in any combination have acceptable diagnostic S to identify patients with severe OSA. STOP-BANG performed best to identify AHI ≥30/h.