Obesity Surgery

, Volume 23, Issue 12, pp 2050–2057 | Cite as

Predictive Performance of the STOP-Bang Score for Identifying Obstructive Sleep Apnea in Obese Patients

Original Contributions

Abstract

Background

The loud Snoring, Tiredness, Observed apnea, high blood Pressure (STOP)-Body mass index (BMI), Age, Neck circumference, and gender (Bang) questionnaire is a validated screening tool for identifying obstructive sleep apnea in surgical patients. However, the predictive performance of the STOP-Bang score in obese and morbidly obese patients remains unknown.

Methods

Preoperative patients were approached for consent and were screened for obstructive sleep apnea (OSA) by the STOP questionnaire. Information concerning Bang was collected. Laboratory or portable polysomnography were performed in 667 patients. Patients with BMI of ≥30 kg/m2 were defined as obese patients and ≥35 kg/m2 as morbidly obese. The predictive parameters (sensitivity, specificity, and positive and negative predictive values) for the STOP-Bang score in obese and morbidly obese patients were analyzed.

Results

In 310 obese patients, a STOP-Bang score of 3 has high sensitivity of 90 % and high positive predictive value of 85 % for identifying obese patient with OSA. A STOP-Bang score of 4 had high sensitivity (87.5 %) and high negative predictive value (90.5 %) for identifying severe OSA, whereas a STOP-Bang score of 6 had high specificity (85.2 %) to identify severe OSA. The diagnostic odds ratio of a STOP-Bang score of 4 was 4.9 for identifying severe OSA. In 140 morbidly obese patients, a STOP-Bang score of 4 had high sensitivity (89.5 %) for identifying severe OSA.

Conclusions

The STOP-Bang score was validated in the obese and morbidly obese surgical patients. For identifying severe OSA, a STOP-Bang score of 4 has high sensitivity of 88 %. For confirming severe OSA, a score of 6 is more specific.

Keywords

STOP-Bang questionnaires Obstructive sleep apnea Morbid obesity Surgery Sleep apnea screening Anesthesia 

Abbreviation

OSA

Obstructive sleep apnea

AHI

Apnea–Hypopnea Index

PSG

Polysomnography

BMI

Body mass index

PPV

Positive predictive value

NPV

Negative predictive value

References

  1. 1.
    Young T, Hutton R, Finn L, et al. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med. 1996;156:2445–51.PubMedCrossRefGoogle Scholar
  2. 2.
    Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31:1079–85.PubMedGoogle Scholar
  3. 3.
    Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin Sleep Cohort. Sleep. 2008;31:1071–8.PubMedGoogle Scholar
  4. 4.
    Kaw R, Chung F, Pasupuleti V, et al. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109:897–906.PubMedCrossRefGoogle Scholar
  5. 5.
    Liao P, Yegneswaran B, Vairavanathan S, et al. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anesth. 2009;56:819–28.PubMedCrossRefGoogle Scholar
  6. 6.
    Memtsoudis S, Liu SS, Ma Y, et al. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg. 2011;112:113–21.PubMedCrossRefGoogle Scholar
  7. 7.
    Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20:705–6.PubMedGoogle Scholar
  8. 8.
    Chung F, Yegneswaran B, Liao P, et al. Validation of Berlin Questionnaire and ASA Checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108:822–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Finkel KJ, Searleman AC, Tymkew H, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med. 2009;10:753–8.PubMedCrossRefGoogle Scholar
  10. 10.
    World Health Organization. Obesity and overweighed fact sheet No 311. May 2012. (http://www.who.int/mediacentre/factsheets/fs311/en/index.html).
  11. 11.
    Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217–39.PubMedCrossRefGoogle Scholar
  13. 13.
    Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Malhotra A, White DP. Obstructive sleep apnoea. Lancet. 2002;360:237–45.PubMedCrossRefGoogle Scholar
  15. 15.
    Vgontzas AN, Tan TL, Bixler EO, et al. Sleep apnea and sleep disruption in obese patients. Arch Intern Med. 1994;154:1705–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Chung F, Yegneswaran B, Liao P, et al. STOP Questionnaire: a tool to screen obstructive sleep apnea. Anesthesiology. 2008;108:812–21.PubMedCrossRefGoogle Scholar
  17. 17.
    Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108:768–75.PubMedCrossRefGoogle Scholar
  18. 18.
    Corso RM, Piraccini E, Agnoletti V, et al. Clinical use of the STOP-BANG questionnaire in patients undergoing sedation for endoscopic procedures. Minerva Anestesiol. 2012;78:109–10.PubMedGoogle Scholar
  19. 19.
    Dias RA, Hardin KA, Rose H, et al. Sleepiness, fatigue, and risk of obstructive sleep apnea using the STOP-BANG questionnaire in multiple sclerosis: a pilot study. Sleep Breath. 2012;16:1255–65.PubMedCrossRefGoogle Scholar
  20. 20.
    Kurrek MM, Cobourn C, Wojtasik Z, et al. Morbidity in patients with or at high risk for obstructive sleep apnea after ambulatory laparoscopic gastric banding. Obes Surg. 2011;21:1494–8.PubMedCrossRefGoogle Scholar
  21. 21.
    McCormack DJ, Pabla R, Babu MH, et al. Undiagnosed sleep apnoea syndrome in patients with acute myocardial infarction: potential importance of the STOP-BANG screening tool for clinical practice. Int J Cardiol. 2012;155:342–3.PubMedCrossRefGoogle Scholar
  22. 22.
    Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89.Google Scholar
  23. 23.
    Chung F, Liao P, Sun Y, et al. Perioperative practical experiences in using a level 2 portable polysomnography. Sleep Breath. 2010;15:367–75.PubMedCrossRefGoogle Scholar
  24. 24.
    Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Standards of Practice Committee of the American Sleep Disorders Association. Sleep. 1994;17:372–7.Google Scholar
  25. 25.
    Iber C, Ancoli-israel S, Cheeson A, et al. The AASM manual for the scoring of sleep and associated events, rules, terminology and technical specifications. Westchester, IL, USA: American Academy of Sleep Medicine; 2007.Google Scholar
  26. 26.
    Obuchowski NA. Sample size calculations in studies of test accuracy. Stat Methods Med Res. 1998;7:371–92.PubMedCrossRefGoogle Scholar
  27. 27.
    Sareli AE, Cantor CR, Williams NN, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary center experience. Obes Surg. 2011;21:316–27.PubMedCrossRefGoogle Scholar
  28. 28.
    Ray P, Le MY, Riou B, et al. Statistical evaluation of a biomarker. Anesthesiology. 2010;112:1023–40.PubMedCrossRefGoogle Scholar
  29. 29.
    Farney RJ, Walker BS, Farney RM, et al. 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. 2011;7:459–65.PubMedGoogle Scholar
  30. 30.
    Peppard PE, Young T, Palta M, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284:3015–21.PubMedCrossRefGoogle Scholar
  31. 31.
    Martinez-Rivera C, Abad J, Fiz JA, et al. Usefulness of truncal obesity indices as predictive factors for obstructive sleep apnea syndrome. Obesity. 2008;16:113–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Heinzer RC, Stanchina ML, Malhotra A, et al. Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea. Thorax. 2006;61:435–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Jordan AS, White DP, Owens RL, et al. The effect of increased genioglossus activity and end-expiratory lung volume on pharyngeal collapse. J Appl Physiol. 2010;109:469–75.PubMedCrossRefGoogle Scholar
  34. 34.
    Schwartz AR, Patil SP, Squier S, et al. Obesity and upper airway control during sleep. J Appl Physiol. 2010;108:430–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Carneiro G, Florio RT, Zanella MT, et al. Is mandatory screening for obstructive sleep apnea with polysomnography in all severely obese patients indicated? Sleep Breath. 2012;16:163–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Daltro C, Gregorio PB, Alves E, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17:809–14.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Anesthesia, Toronto Western Hospital, University Health NetworkUniversity of TorontoTorontoCanada

Personalised recommendations