Predictive Performance of the STOP-Bang Score for Identifying Obstructive Sleep Apnea in Obese Patients
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.
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.
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.
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.
KeywordsSTOP-Bang questionnaires Obstructive sleep apnea Morbid obesity Surgery Sleep apnea screening Anesthesia
Obstructive sleep apnea
Body mass index
Positive predictive value
Negative predictive value
- 10.World Health Organization. Obesity and overweighed fact sheet No 311. May 2012. (http://www.who.int/mediacentre/factsheets/fs311/en/index.html).
- 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
- 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.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