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Sleep and Breathing

, Volume 22, Issue 3, pp 757–765 | Cite as

STOP-Bang questionnaire: the validation of a Portuguese version as a screening tool for obstructive sleep apnea (OSA) in primary care

  • Alexandre Rebelo-Marques
  • Cláudia Vicente
  • Bruno Valentim
  • Marcos Agostinho
  • Rosália Pereira
  • Maria Fátima Teixeira
  • Joaquim Moita
Sleep Breathing Physiology and Disorders • Original Article

Abstract

Introduction

The growing number of suspected patients diagnosed with obstructive sleep apnea (OSA) that are observed in sleep units has increased in the last decade. Therefore, screening methods have become important, especially in primary care (PC).

Aim

This work aimed to test the performance of the STOP-Bang questionnaire for the suspicion/diagnosis of obstructive sleep apnea.

Methods

Eight-month prospective study; all patients referred from PC to the respective sleep clinic accompanied by a completed and translated version of the STOP-Bang questionnaire for a clinical evaluation.

Results

Two hundred fifty-nine observed patients were the study object. The age was 55.14 ± 12.07 years, 71.03% were male patients with a neck circumference of 40.97 ± 3.07 cm and BMI of 31.1 ± 5.14 kg/m2. The diagnosis was confirmed in 82.6% of the patients: 34.6% having moderate and 36.8% severe disease. A STOP-Bang score of 3 or more resulted in positive predictive value (PPV) of 88.4% and a sensitivity for OSA of 98.6%. Has the questionnaire score raises, OSA’s probability also raises in a proportional basis. For a STOP-Bang score of 6, the OSA probability reaches 98% and for a score of 8, it reaches 80% for severe OSA. Lower scores, 3 or 2, had a negative predictive value (NPV) for moderate-to-severe OSA of 86.96 and 87.5%, respectively.

Conclusion

As much as we know, our study is the first that applied the STOP-Bang questionnaire in Portuguese PC. We demonstrate that these is a useful tool for the stratification of patients with suspicion and diagnosis of OSA, showing a high sensitivity and PPV. Besides that, the probability of severe OSA steadily increases along with its score and we show an excellent NPV with lower scores.

Keywords

Obstructive sleep apnea Polysomnography Screening tool Primary care STOP-Bang questionnaire Diagnosis 

Notes

Funding information

The authors declare that no funding was received for this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The authors declare that the protocol of the research work was approved by the Ethics Commission of the Regional Health Administration (ARS Centro) according to the Helsinki Declaration, and all the patients provided written informed consent.

Supplementary material

References

  1. 1.
    Jennum P, Riha RL (2009) Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing. Eur Respir J 33(4):907–914.  https://doi.org/10.1183/09031936.00180108 CrossRefPubMedGoogle Scholar
  2. 2.
    Lettieri CJ, Eliasson AH, Andrada T, Khramtsov A, Raphaelson M, Kristo DA (2005) Obstructive sleep apnea syndrome: are we missing an at-risk population? Chest J 128(4_MeetingAbstracts):133S-b.  https://doi.org/10.1378/chest.128.4_MeetingAbstracts.133S-b CrossRefGoogle Scholar
  3. 3.
    Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, …, Hla KM (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31(8)1071–1078Google Scholar
  4. 4.
    Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR (2008) Sleep apnea as an independent risk factor for all-cause mortality: the Busselton health study. Sleep 31(8):1079–1085PubMedPubMedCentralGoogle Scholar
  5. 5.
    McNicholas WT, Bonsignore MR, Management Committee of EU Cost Action B26 (2007) Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J 29(1):156–178.  https://doi.org/10.1183/09031936.00027406 CrossRefPubMedGoogle Scholar
  6. 6.
    Ancoli-Israel S, Ancoli-Israel S, Kripke DF, Kripke DF, Klauber MR, Mason WJ, …, Kaplan O (1991) Sleep-disordered breathing in community-dwelling elderly. Sleep 14(6):486–495Google Scholar
  7. 7.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545.  https://doi.org/10.1093/sleep/14.6.540 CrossRefPubMedGoogle Scholar
  8. 8.
    Johns MW (1992) Reliability and factor analysis of the Epworth sleepiness scale. Sleep 15(4):376–381.  https://doi.org/10.1093/sleep/15.4.376 CrossRefPubMedGoogle Scholar
  9. 9.
    Ross SD, Sheinihait IA, Harrison KJ, Kvasz M, Connelly JE, Shea SA, Allen IE (2000) Systematic review and meta-analysis of the literature regarding the diagnosis of sleep apnea. Sleep 23(4):519–534CrossRefPubMedGoogle Scholar
  10. 10.
    Rowley JA, Aboussouan LS, Badr MS (2000) The use of clinical prediction formulas in the evaluation of obstructive sleep apnea. Sleep 23(7):929–938.  https://doi.org/10.1093/sleep/23.7.929 CrossRefPubMedGoogle Scholar
  11. 11.
    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, …, Shapiro CM (2008) Stop questionnaire a tool to screen patients for obstructive sleep apnea. Anesthesiol J Am Soc Anesthesiol 108(5):812–821Google Scholar
  12. 12.
    Sperber AD (2004) Translation and validation of study instruments for cross-cultural research. Gastroenterology 126(1 Suppl 1):S124–S128.  https://doi.org/10.1053/j.gastro.2003.10.016 CrossRefPubMedGoogle Scholar
  13. 13.
    Sousa VD, Rojjanasrirat W (2011) Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract 17(2):268–274.  https://doi.org/10.1111/j.1365-2753.2010.01434.x CrossRefPubMedGoogle Scholar
  14. 14.
    Reis R, Teixeira F, Martins V, Sousa L, Batata L, Santos C, Moutinho J (2015) Validation of a Portuguese version of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea: analysis in a sleep clinic. Revista Portuguesa de Pneumologia (English Edition) 21(2):61–68.  https://doi.org/10.1016/j.rppnen.2014.04.009 CrossRefGoogle Scholar
  15. 15.
    Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, …, Schwab R (2007) Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 3(7):737–747Google Scholar
  16. 16.
    Collop NA, Tracy SL, Kapur V, Mehra R, Kuhlmann D, Fleishman SA, Ojile JM (2011) Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med 7(5):531–548.  https://doi.org/10.5664/JCSM.1328 PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Rosen CL, Auckley D, Benca R, Foldvary-Schaefer N, Iber C, Kapur V, …, Redline S (2012) A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sleep 35(6):757–767Google Scholar
  18. 18.
    Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus CL, Vaughn BV (2012) The AASM manual for the scoring of sleep and associated events. Rules, Terminology and Technical Specifications, Darien, Illinois, American Academy of Sleep MedicineGoogle Scholar
  19. 19.
    Force AOSAT, American Academy of Sleep Medicine (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5(3):263Google Scholar
  20. 20.
    Quan SF, Gillin JC, Littner MR, Shepard JW (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Editorials. Sleep. Am Acad Sleep Med 22(5):662–689.  https://doi.org/10.1093/sleep/22.5.662 CrossRefPubMedGoogle Scholar
  21. 21.
    Sateia MJ (2014) International classification of sleep disorders—highlights and modifications. Chest J 146(5):1387–1394.  https://doi.org/10.1378/chest.14-0970 CrossRefGoogle Scholar
  22. 22.
    Abrishami A, Khajehdehi A, Chung F (2010) A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anesth 57(5):423–438.  https://doi.org/10.1007/s12630-010-9280-x CrossRefPubMedGoogle Scholar
  23. 23.
    Sharma SK, Kumpawat S, Banga A, Goel A (2006) Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest J 130(1):149–156.  https://doi.org/10.1378/chest.130.1.149 CrossRefGoogle Scholar
  24. 24.
    Ramachandran SK, Josephs LA (2009) A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology 110(4):928–939.  https://doi.org/10.1097/ALN.0b013e31819c47b6 CrossRefPubMedGoogle Scholar
  25. 25.
    Douglass AB, Bomstein R, Nino-Murcia G, Keenan S, Miles L, Zarcone VP Jr, …, Dement WC (1994) The sleep disorders questionnaire I: creation and multivariate structure of SDQ. Sleep 17(2):160–167Google Scholar
  26. 26.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491.  https://doi.org/10.7326/0003-4819-131-7-199910050-00002 CrossRefPubMedGoogle Scholar
  27. 27.
    Haraldsson PO, Carenfelt C, Knutsson E, Persson HE, Rinder J (1992) Preliminary report: validity of symptom analysis and daytime polysomnography in diagnosis of sleep apnea. Sleep 15(3):261–263.  https://doi.org/10.1093/sleep/15.3.261 CrossRefPubMedGoogle Scholar
  28. 28.
    Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Coté CJ, …, Ydens L (2006) Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 104(5):1081Google Scholar
  29. 29.
    Farney RJ, Walker BS, Farney RM, Snow GL, Walker JM (2011) The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med 7(5):459–65B.  https://doi.org/10.5664/JCSM.1306 PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Silva GE, Vana KD, Goodwin JL, Sherrill DL, Quan SF (2011) Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth sleepiness scales. J Clin Sleep Med 7(5):467–472.  https://doi.org/10.5664/JCSM.1308 PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y (2012) High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth 108(5):768–775.  https://doi.org/10.1093/bja/aes022 CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Takegami M, Hayashino Y, Chin K, Sokejima S, Kadotani H, Akashiba T, Kimura H, Ohi M, Fukuhara S (2009) Simple four-variable screening tool for identification of patients with sleep-disordered breathing. Sleep 32(7):939–948. https://www.ncbi.nlm.nih.gov/pubmed/19639757
  33. 33.
    Chung F, Abdullah HR, Liao P (2016) STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest J 149(3):631–638.  https://doi.org/10.1378/chest.15-0903 CrossRefGoogle Scholar
  34. 34.
    Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, …, Chung, F. (2015) Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS One 10(12):e0143697Google Scholar
  35. 35.
    Yang Y, Chung F (2013) A screening tool of obstructive sleep apnea. Sleep Med Clin 8(1):65–72.  https://doi.org/10.1016/j.jsmc.2012.11.004 CrossRefGoogle Scholar
  36. 36.
    Boynton G, Vahabzadeh A, Hammoud S, Ruzicka DL, Chervin RD (2013) Validation of the STOP-BANG questionnaire among patients referred for suspected obstructive sleep apnea. J Sleep Dis Treat Care 2(4). https://www.ncbi.nlm.nih.gov/pubmed/24800262
  37. 37.
    Ong TH, Raudha S, Fook-Chong S, Lew N, Hsu AAL (2010) Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population. Sleep Breath 14(4):371–376.  https://doi.org/10.1007/s11325-010-0350-7 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • Alexandre Rebelo-Marques
    • 1
    • 2
  • Cláudia Vicente
    • 3
  • Bruno Valentim
    • 1
  • Marcos Agostinho
    • 4
  • Rosália Pereira
    • 1
  • Maria Fátima Teixeira
    • 5
  • Joaquim Moita
    • 5
  1. 1.USF Condeixa, ACeS Baixo Mondego, ARS CentroCoimbraPortugal
  2. 2.Faculty of MedicineUniversity of CoimbraCoimbraPortugal
  3. 3.UCSP Mealhada, ACeS Baixo Mondego, ARS CentroCoimbraPortugal
  4. 4.USF Santa Cruz, ACeS Oeste SulARS Lisboa e Vale do TejoLisbonPortugal
  5. 5.Sleep Medicine CentreCoimbra Hospital and University CenterCoimbraPortugal

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