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STOP-Bang Modification for Screening Treatment-Relevant Obstructive Sleep Apnea in Cluster Headache: A Retrospective
Mi-Kyoung Kang1, Yooha Hong1, Hee-Jin Im1
1Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si 18450, Republic of Korea.
Journal of Clinical Medicine
|August 13, 2026
Summary
Screening for obstructive sleep apnea (OSA) in cluster headache (CH) patients can be improved by modifying the STOP-Bang questionnaire to include age at CH onset. This refinement aids in identifying patients needing treatment for OSA.
Area of Science:
- Neurology
- Sleep Medicine
- Cardiovascular Health
Background:
- Cluster headache (CH) and obstructive sleep apnea (OSA) share risk factors like cardiovascular disease and unhealthy lifestyles.
- Effective screening for OSA in CH patients is crucial due to overlapping health risks.
Purpose of the Study:
- To evaluate if a modified STOP-Bang questionnaire, incorporating CH-specific features, enhances the identification of treatment-relevant OSA in CH patients.
- To compare the screening performance of the conventional STOP-Bang questionnaire against a modified version.
Main Methods:
- Retrospective analysis of 52 CH patients undergoing polysomnography (PSG).
- Definition of treatment-relevant OSA as an apnea-hypopnea index (AHI) ≥ 10 events/hour.
- Assessment of modified STOP-Bang incorporating CH onset age and attack rhythmicity.
Main Results:
- 48.1% of CH patients had treatment-relevant OSA; predominantly male with higher BMI and earlier CH onset age.
- A modified model including CH onset ≥ age 30 showed improved screening performance (AUC 0.804 vs. 0.767) and sensitivity (84.0% vs. 76.0%).
- Increasing the cut-off to ≥4 improved specificity to 77.8% without further enhancing performance with other CH features.
Conclusions:
- Modifying the STOP-Bang questionnaire by including CH onset age offers a practical improvement for screening treatment-relevant OSA in CH patients.
- This refined screening approach requires external validation for broader clinical application.
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