STOP-BANG Scoring Model*

SNORING  Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?

T  TIRED  Do you often feel tired, fatigued, or sleepy during daytime?

O OBSERVED  Has anyone observed you stop breathing during your sleep?

P BLOOD PRESSURE  Do you have or are you being treated for high blood pressure?

 

B BMI  BMI more than 35 kg/m2**?

A AGE  Age over 50 yr old?

N NECK CIRCUMFERENCE  Neck circumference greater than 40 cm (16 in)?

G GENDER   Gender male?

 

**For imperial conversion use lb/in2 x 705
1Stensland SH and Margolis S. J Am Diet Assoc 1990; 90(6): 856.

 

High risk of OSA:

Answering YES to three or more items

 

Low risk of OSA:

Answering YES to less than three items  

 

STOP Questionnaire: A Tool to Screen Patients for Obstructive Sleep Apnea

 

Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A and Shapiro CM. Anesthesiology 2008; 108(5): 812-21.

TAKE-HOME POINT:
The STOP-BANG scoring model* (questionnaire) is a highly sensitive, quick and easy-to-use tool for identifying pre-operative patients who have obstructive sleep apnea (OSA).

AIM:
This study was conducted to develop and validate a concise and easy-to-use questionnaire for OSA screening of surgical patients.

METHODS:
2,467 participants (18 years and older, undergoing elective surgery with no previous OSA diagnosis) completed the STOP questionnaire.
Of those 2467, 177 volunteers underwent polysomnography in order to validate the STOP questionnaire.

After the STOP questionnaire was validated, the BANG parameters (i.e., BM I, age, neck circumference and gender) were added to the analysis. The aim of this was to determine whether sensitivity, i.e. accuracy in predicting the existence of OSA, could be increased by adding these additional potential predictors. The result was the STOP-BANG model.*

RESULTS:

  • The average apnea-hypopnea index (AH I) in the validation group was 20 ± 6 events per hour.
  • The STOP questionnaire alone provided a high degree of sensitivity i.e. accuracy in predicting the existence of OSA – refer to Table 1 below.
  • The addition of the four BANG parameters to the STOP questionnaire, i.e. the STOP-BANG scoring model, increased the sensitivity markedly — refer to Table 1.
Table 1: Sensitivity of Questionnaires in Accurately Predicting Moderate to Severe OSA
STOP Questionnaire Alone SensitivitySTOP-BANG Questionnaire Sensitivity
AHI greater than 565.6%83.6%
AHI greater than 1574.3%92.9%
AH I greater than 3079.5%100.0%

CONCLUSIONS:

The STOP questionnaire is a concise and easy-to-use screening tool for OSA which has been validated for surgical patients.

Combined with the BANG parameters, the STOP-BANG scoring model achieved even greater sensitivity than the STOP questionnaire alone in identifying patients with moderate to severe OSA.