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STOP-BANG screener vs objective obstructive sleep apnea testing among younger veterans with PTSD and insomnia:

Robert Lyons1,2, Lara A Barbir3, Robert Owens4

  • 1San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine
|July 3, 2021
PubMed

Insights

The STOP-BANG screener is not effective for identifying obstructive sleep apnea (OSA) in younger veterans with posttraumatic stress disorder (PTSD). Objective testing is recommended for this population to ensure accurate OSA diagnosis.

Area of Science:

  • Sleep Medicine
  • Veterans Health
  • Diagnostic Accuracy

Background:

  • Posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) frequently co-occur, even in younger veterans with lower body mass index.
  • The STOP-BANG questionnaire, commonly used for OSA screening, may not be suitable for veterans with PTSD due to its reliance on factors like age and body mass index.
  • Untreated OSA has significant negative health consequences, highlighting the need for effective screening in at-risk populations.

Purpose of the Study:

  • To compare the effectiveness of the STOP-BANG screener against objective diagnostic testing for obstructive sleep apnea (OSA) in younger veterans diagnosed with posttraumatic stress disorder (PTSD).
  • To evaluate the diagnostic performance of the STOP-BANG questionnaire, including different cut-off scores, in identifying OSA among this specific veteran cohort.

Main Methods:

  • The study involved 48 younger veterans with PTSD undergoing treatment for insomnia.
  • Objective OSA diagnosis was determined using NOX T3 sleep monitors to calculate the apnea-hypopnea index (AHI).
  • Logistic regression and chi-square goodness-of-fit tests were employed to analyze the performance of the STOP-BANG screener and its individual items.

Main Results:

  • The STOP-BANG screener demonstrated high sensitivity but poor specificity for OSA detection (AHI ≥ 5 events/h) when using a cut-off score of ≥ 3.
  • A higher cut-off score (≥ 5) improved specificity but significantly reduced sensitivity, indicating missed OSA cases.
  • Individual STOP-BANG items showed varied performance, with tiredness and sex being more indicative of OSA than body mass index, age, or neck circumference in this population.

Conclusions:

  • The STOP-BANG questionnaire is insufficient for accurately screening obstructive sleep apnea (OSA) in younger veterans with posttraumatic stress disorder (PTSD).
  • Objective diagnostic testing for OSA is crucial for veterans with PTSD to avoid underdiagnosis.
  • Further research is warranted to develop and validate more precise OSA screening tools tailored for this demographic.
Abstract

Keywords:
OSAPTSDSTOP-BANGobstructive sleep apneaposttraumatic stress disorder

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