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Current Sleep Medicine Reports

, Volume 4, Issue 3, pp 221–230 | Cite as

Screening for Sleep Apnea: When and How?

  • Ricardo Luiz de Menezes Duarte
  • Flavio José Magalhães-da-Silveira
  • David Gozal
Sleep Related Breathing Disorders (L Kheirandish-Gozal, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Sleep Related Breathing Disorders

Abstract

Purpose of Review

Several models aimed at screening for obstructive sleep apnea (OSA) have been published, and most of these are based on questions containing clinical, demographic, and anthropometric features previously identified as OSA risk factors. Here, our main objective was to review the usefulness of some of these screening tools and delineate their performance when attempting to identify subjects at risk for OSA.

Recent Findings

We evaluated some of the most cited screening tools including Sleep Apnea Clinical Score, Berlin and STOP-Bang questionnaires, Four-Variable Screening Tool, NoSAS score, and the Epworth Sleepiness Scale. Analysis of the predictive performance of the different tools is influenced by the sleep test used, the type of population studied, and the threshold of the apnea/hypopnea index used for OSA diagnosis.

Summary

Nowadays, it would appear that the most employed screening instrument is the STOP-Bang questionnaire. It is a mnemonic method with eight questions dichotomized into yes-or-no responses and exhibits high sensitivity at all levels of OSA severity while also having been widely validated in several different populations.

Keywords

Obstructive sleep apnea Polysomnography Diagnostic test Screening 

Notes

Compliance with Ethical Standards

Conflict of Interest

Ricardo L. M. Duarte, Flavio J. Magalhães-da-Silveira, and David Gozal each declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo epidemiologic sleep study. Sleep Med. 2010;11(5):441–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Duarte RL, Magalhães-da-Silveira FJ. Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography. J Bras Pneumol. 2015;41(5):440–8.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kositanurit W, Muntham D, Udomsawaengsup S, Chirakalwasan N. Prevalence and associated factors of obstructive sleep apnea in morbidly obese patients undergoing bariatric surgery. Sleep Breath. 2018;22(1):251–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Muxfeldt ES, Margallo VS, Guimarães GM, Salles GF. Prevalence and associated factors of obstructive sleep apnea in patients with resistant hypertension. Am J Hypertens. 2014;27(8):1069–78.CrossRefPubMedGoogle Scholar
  7. 7.
    Logan AG, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001;19(12):2271–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Johnson KG, Johnson DC. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med. 2010;6(2):131–7.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284–91.CrossRefPubMedGoogle Scholar
  10. 10.
    Gabbay IE, Lavie P. Age- and gender-related characteristics of obstructive sleep apnea. Sleep Breath. 2012;16(2):453–60.CrossRefPubMedGoogle Scholar
  11. 11.
    Mokhlesi B, Ham SA, Gozal D. The effect of sex and age on the comorbidity burden of OSA: an observational analysis from a large nationwide US health claims database. Eur Respir J. 2016;47(4):1162–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Muraja-Murro A, Kulkas A, Hiltunen M, Kupari S, Hukkanen T, Tiihonen P, et al. The severity of individual obstruction events is related to increased mortality rate in severe obstructive sleep apnea. J Sleep Res. 2013;22(6):663–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071–8.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med. 2004;169(6):668–72.CrossRefPubMedGoogle Scholar
  15. 15.
    Rotenberg B, George C, Sullivan K, Wong E. Wait times for sleep apnea care in Ontario: a multidisciplinary assessment. Can Respir J. 2010;17(4):170–4.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479–504.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    •• Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anesth. 2010;57(5):423–38. Detailed systematic review on several screening models applied in clinical practice: inconsistency of results possibly due to studies with heterogeneous design (population, questionnaire type, and validity). CrossRefPubMedGoogle Scholar
  18. 18.
    •• Ramachandran SK, Josephs LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology. 2009;110(4):928–39. Meta-analysis designed to compare clinical screening tests for obstructive sleep apnea and establish an evidence base for their preoperative use. CrossRefPubMedGoogle Scholar
  19. 19.
    Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al. 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. 2007;3(7):737–47.PubMedGoogle Scholar
  20. 20.
    Roesslein M, Chung F. Obstructive sleep apnoea in adults: peri-operative considerations: a narrative review. Eur J Anaesthesiol. 2018;35(4):245–55.PubMedGoogle Scholar
  21. 21.
    • Nagappa M, Patra J, Wong J, Subramani Y, Singh M, Ho G, et al. Association of STOP-Bang questionnaire as a screening tool for sleep apnea and postoperative complications: a systematic review and Bayesian meta-analysis of prospective and retrospective cohort studies. Anesth Analg. 2017;125(4):1301–8. Systematic review and meta-analysis of the main complications present in surgical patients screened with STOP-Bang. This study supports the implementation of the STOP-Bang questionnaire as a perioperative risk stratification tool. CrossRefPubMedGoogle Scholar
  22. 22.
    Ramachandran SK, Pandit J, Devine S, Thompson A, Shanks A. Postoperative respiratory complications in patients at risk for obstructive sleep apnea: a single-institution cohort study. Anesth Analg. 2017;125(1):272–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Dimitrov L, Macavei V. Can screening tools for obstructive sleep apnea predict postoperative complications? A systematic review of the literature. J Clin Sleep Med. 2016;12(9):1293–300.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    • Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, et al. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US preventive services task force. JAMA. 2017;317(4):415–33. The US Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults CrossRefPubMedGoogle Scholar
  25. 25.
    Lopez PP, Stefan B, Schulman CI, Byers PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg. 2008;74(9):834–8.PubMedGoogle Scholar
  26. 26.
    Ravesloot MJ, van Maanen JP, Hilgevoord AA, van Wagensveld BA, de Vries N. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. Eur Arch Otorhinolaryngol. 2012;269(7):1865–71.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Heinzer RC, Stanchina ML, Malhotra A, Jordan AS, Patel SR, Lo YL, et al. Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea. Thorax. 2006;61(5):435–9.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Stanchina ML, Malhotra A, Fogel RB, Trinder J, Edwards JK, Schory K, et al. The influence of lung volume on pharyngeal mechanics, collapsibility, and genioglossus muscle activation during sleep. Sleep. 2003;26(7):851–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.CrossRefPubMedGoogle Scholar
  30. 30.
    Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T. Progression and regression of sleep-disordered breathing with changes in weight: the sleep heart health study. Arch Intern Med. 2005;165(20):2408–13.CrossRefPubMedGoogle Scholar
  31. 31.
    Tishler PV, Larkin EK, Schluchter MD, Redline S. Incidence of sleep disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA. 2003;289(17):2230–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Grunstein RR, Stenlöf K, Hedner JA, Peltonen M, Karason K, Sjöström L. Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. Sleep. 2007;30(6):703–10.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Davies RJ, Ali NJ, Stradling JR. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax. 1992;47(2):101–5.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax. 1991;46(2):85–90.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Kawaguchi Y, Fukumoto S, Inaba M, Koyama H, Shoji T, Shoji S, et al. Different impacts of neck circumference and visceral obesity on the severity of obstructive sleep apnea syndrome. Obesity. 2011;19(2):276–82.CrossRefPubMedGoogle Scholar
  36. 36.
    Jordan AS, McEvoy RD. Gender differences in sleep apnea: epidemiology, clinical presentation and pathogenic mechanisms. Sleep Med Rev. 2003;7(5):377–89.CrossRefPubMedGoogle Scholar
  37. 37.
    Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3 Pt 1):608–13.CrossRefPubMedGoogle Scholar
  38. 38.
    Malhotra A, Huang Y, Fogel RB, Pillar G, Edwards JK, Kikinis R, et al. The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med. 2002;166(10):1388–95.CrossRefPubMedGoogle Scholar
  39. 39.
    Mirer AG, Young T, Palta M, Benca RM, Rasmuson A, Peppard PE. Sleep-disordered breathing and the menopausal transition among participants in the sleep in midlife women study. Menopause. 2017;24(2):157–62.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Baldwin CM, Kapur VK, Holberg CJ, Rosen C, Nieto FJ. Sleep heart health study group. Associations between gender and measures of daytime somnolence in the sleep heart health study. Sleep. 2004;27(2):305–11.CrossRefPubMedGoogle Scholar
  41. 41.
    Yamakoshi S, Kasai T, Tomita Y, Takaya H, Kasagi S, Kawabata M, et al. Comparison of clinical features and polysomnographic findings between men and women with sleep apnea. J Thorac Dis. 2016;8(1):145–51.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Vagiakis E, Kapsimalis F, Lagogianni I, Perraki H, Minaritzoglou A, Alexandropoulou K, et al. Gender differences on polysomnographic findings in Greek subjects with obstructive sleep apnea syndrome. Sleep Med. 2006;7(5):424–30.CrossRefPubMedGoogle Scholar
  43. 43.
    Basoglu OK, Tasbakan MS. Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients. Sleep Breath. 2018;22(1):241–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Valipour A, Lothaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P. Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep. 2007;30(3):312–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Nigro CA, Dibur E, Borsini E, Malnis S, Ernst G, Bledel I, et al. The influence of gender on symptoms associated with obstructive sleep apnea. Sleep Breath. 2018;  https://doi.org/10.1007/s11325-017-1612-4.
  46. 46.
    Dancey DR, Hanly PJ, Soong C, Lee B, Shepard J Jr, Hoffstein V. Gender differences in sleep apnea: the role of neck circumference. Chest. 2003;123(5):1544–50.CrossRefPubMedGoogle Scholar
  47. 47.
    Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med. 1998;157(1):144–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Ancoli-Israel S, Kripke DF, Klauber MR, Fell R, Stepnowsky C, Estline E, et al. Morbidity, mortality and sleep-disordered breathing in community dwelling elderly. Sleep. 1996;19(4):277–82.CrossRefPubMedGoogle Scholar
  49. 49.
    Malhotra A, Huang Y, Fogel R, Lazic S, Pillar G, Jakab M, et al. Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse. Am J Med. 2006;119(1):72.e9–14.CrossRefGoogle Scholar
  50. 50.
    Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK, Amaro AC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58(5):811–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Dernaika TA, Kinasewitz GT, Tawk MM. Effects of nocturnal continuous positive airway pressure therapy in patients with resistant hypertension and obstructive sleep apnea. J Clin Sleep Med. 2009;5(2):103–7.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Martínez-García MA, Capote F, Campos-Rodríguez F, Lloberes P, Díaz de Atauri MJ, Somoza M, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013;310(22):2407–15.CrossRefPubMedGoogle Scholar
  53. 53.
    • Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructive sleep apnea? The rational clinical examination systematic review. JAMA. 2013;310(7):731–41. Careful systematic review of the various items of signs and symptoms used in the clinical suspicion of obstructive sleep apnea: nocturnal gasping or choking is the most reliable indicator of obstructive sleep apnea, whereas snoring is not very specific CrossRefPubMedGoogle Scholar
  54. 54.
    • Steyerberg EW, Vickers AJ, Cook NR, Gerds T, Gonen M, Obuchowski N, et al. Assessing the performance of prediction models: a framework for some traditional and novel measures. Epidemiology. 2010;21(1):128–38. This study shows useful measures for assessing performance of predictive models as Brier score to indicate overall performance, discriminative ability by area under the receiver operating characteristic curve, and goodness-of-fit statistics for calibration CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983;148(3):839–43.CrossRefPubMedGoogle Scholar
  56. 56.
    DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.CrossRefPubMedGoogle Scholar
  57. 57.
    Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med. 1994;150(5 Pt 1):1279–85.CrossRefPubMedGoogle Scholar
  58. 58.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485–91.CrossRefPubMedGoogle Scholar
  59. 59.
    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812–21.CrossRefPubMedGoogle Scholar
  60. 60.
    Takegami M, Hayashino Y, Chin K, Sokejima S, Kadotani H, Akashiba T, et al. Simple four-variable screening tool for identification of patients with sleep-disordered breathing. Sleep. 2009;32(7):939–48.PubMedPubMedCentralGoogle Scholar
  61. 61.
    Marti-Soler H, Hirotsu C, Marques-Vidal P, Vollenweider P, Waeber G, Preisig M, et al. The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. Lancet Respir Med. 2016;4(9):742–8.CrossRefPubMedGoogle Scholar
  62. 62.
    Cowan DC, Allardice G, Macfarlane D, Ramsay D, Ambler H, Banham S, et al. Predicting sleep disordered breathing in outpatients with suspected OSA. BMJ Open. 2014;4(4):e004519.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Ahmadi N, Chung SA, Gibbs A, Shapiro CM. The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurements of respiratory disturbances. Sleep Breath. 2008;12(1):39–45.CrossRefPubMedGoogle Scholar
  64. 64.
    Senaratna CV, Perret JL, Matheson MC, Lodge CJ, Lowe AJ, Cassim R, et al. Validity of the Berlin questionnaire in detecting obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev. 2017;36:116–24.CrossRefPubMedGoogle Scholar
  65. 65.
    Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, et al. Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev. 2017;36:57–70.CrossRefPubMedGoogle Scholar
  66. 66.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.CrossRefPubMedGoogle Scholar
  67. 67.
    Vana KD, Silva GE, Goldberg R. Predictive abilities of the STOP-Bang and Epworth sleepiness scale in identifying sleep clinic patients at high risk for obstructive sleep apnea. Res Nurs Health. 2013;36(1):84–94.CrossRefPubMedGoogle Scholar
  68. 68.
    Panchasara B, Poots AJ, Davies G. Are the Epworth sleepiness scale and Stop-Bang model effective at predicting the severity of obstructive sleep apnoea (OSA); in particular OSA requiring treatment? Eur Arch Otorhinolaryngol. 2017;274(12):4233–9.CrossRefPubMedGoogle Scholar
  69. 69.
    Soler X, Liao S-Y, Marin JM, Lorenzi-Filho G, Jen R, DeYoung P, et al. Age, gender, neck circumference, and Epworth sleepiness scale do not predict obstructive sleep apnea (OSA) in moderate to severe chronic obstructive pulmonary disease (COPD): the challenge to predict OSA in advanced COPD. PLoS One. 2017;12(5):e0177289.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Mediano O, Barceló A, de la Peña M, Gozal D, Agustí A, Barbé F. Daytime sleepiness and polysomnographic variables in sleep apnoea patients. Eur Respir J. 2007;30(1):110–3.CrossRefPubMedGoogle Scholar
  71. 71.
    Gali B, Whalen FX, Gay PC, Olson EJ, Schroeder DR, Plevak DJ, et al. Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome. J Clin Sleep Med. 2007;3(6):582–8.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Gali B, Whalen FX, Schroeder DR, Gay PC, Plevak DJ. Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology. 2009;110(4):869–77.CrossRefPubMedGoogle Scholar
  73. 73.
    Prasad KT, Sehgal IS, Agarwal R, Nath Aggarwal A, Behera D, Dhooria S. Assessing the likelihood of obstructive sleep apnea: a comparison of nine screening questionnaires. Sleep Breath. 2017;21(4):909–17.CrossRefPubMedGoogle Scholar
  74. 74.
    Sforza E, Chouchou F, Pichot V, Herrmann F, Barthélémy JC, Roche F. Is the Berlin questionnaire a useful tool to diagnose obstructive sleep apnea in the elderly? Sleep Med. 2011;12(2):142–6.CrossRefPubMedGoogle Scholar
  75. 75.
    Margallo VS, Muxfeldt ES, Guimarães GM, Salles GF. Diagnostic accuracy of the Berlin questionnaire in detecting obstructive sleep apnea in patients with resistant hypertension. J Hypertens. 2014;32(10):2030–6.CrossRefPubMedGoogle Scholar
  76. 76.
    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108(5):822–30.CrossRefPubMedGoogle Scholar
  77. 77.
    Chung F, Yang Y, Brown R, Liao P. Alternative scoring models of STOP-Bang questionnaire improve specificity to detect undiagnosed obstructive sleep apnea. J Clin Sleep Med. 2014;10(9):951–8.PubMedPubMedCentralGoogle Scholar
  78. 78.
    Farney RJ, Walker BS, Farney RM, Snow GL, Walker JM. 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(5):459–65.PubMedPubMedCentralGoogle Scholar
  79. 79.
    Ong TH, Raudha S, Fook-Chong S, Lew N, Hsu AA. Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population. Sleep Breath. 2010;14(4):371–6.CrossRefPubMedGoogle Scholar
  80. 80.
    Pereira EJ, Driver HS, Stewart SC, Fitzpatrick MF. Comparing a combination of validated questionnaires and level III portable monitor with polysomnography to diagnose and exclude sleep apnea. J Clin Sleep Med. 2013;9(12):1259–66.PubMedPubMedCentralGoogle Scholar
  81. 81.
    Duarte RLM, Fonseca LBM, Magalhães-da-Silveira FJ, Silveira EAD, Rabahi MF. Validation of the STOP-Bang questionnaire as a means of screening for obstructive sleep apnea in adults in Brazil. J Bras Pneumol. 2017;43(6):456–63.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Guralnick AS, Pant M, Minhaj M, Sweitzer BJ, Mokhlesi B. CPAP adherence in patients with newly diagnosed obstructive sleep apnea prior to elective surgery. J Clin Sleep Med. 2012;8(5):501–6.PubMedPubMedCentralGoogle Scholar
  83. 83.
    Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108(5):768–75.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Chia P, Seet E, Macachor JD, Iyer US, Wu D. The association of pre-operative STOP-BANG scores with postoperative critical care admission. Anaesthesia. 2013;68(9):950–2.CrossRefPubMedGoogle Scholar
  85. 85.
    Silva GE, Vana KD, Goodwin JL, Sherrill DL, Quan SF. Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth sleepiness scales. J Clin Sleep Med. 2011;7(5):467–72.PubMedPubMedCentralGoogle Scholar
  86. 86.
    Tan A, Yin JD, Tan LW, van Dam RM, Cheung YY, Lee CH. Predicting obstructive sleep apnea using the STOP-Bang questionnaire in the general population. Sleep Med. 2016;27-28:66–71.CrossRefPubMedGoogle Scholar
  87. 87.
    Popević MB, Milovanović A, Nagorni-Obradović L, Nešić D, Milovanović J, Milovanović APS. Screening commercial drivers for obstructive sleep apnea: validation of STOP-Bang questionnaire. Int J Occup Med Environ Health. 2017;30(5):751–61.PubMedGoogle Scholar
  88. 88.
    Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg. 2013;23(12):2050–7.CrossRefPubMedGoogle Scholar
  89. 89.
    •• Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, et al. 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. 2015;10(12):e0143697. Meta-analysis and systematic review of the several studies validating the STOP-Bang questionnaire in several settings Google Scholar
  90. 90.
    Chung F, Chau E, Yang Y, Liao P, Hall R, Mokhlesi B. Serum bicarbonate level improves specificity of STOP-Bang screening for obstructive sleep apnea. Chest. 2013;143(5):1284–93.CrossRefPubMedGoogle Scholar
  91. 91.
    Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016;149(3):631–8.CrossRefPubMedGoogle Scholar
  92. 92.
    Kunisaki KM, Brown KE, Fabbrini AE, Wetherbee EE, Rector TS. STOP-BANG questionnaire performance in a veterans affairs unattended sleep study program. Ann Am Thorac Soc. 2014;11(2):192–7.CrossRefPubMedGoogle Scholar
  93. 93.
    Doshi V, Walia R, Jones K, Aston CE, Awab A. STOP-BANG questionnaire as a screening tool for diagnosis of obstructive sleep apnea by unattended portable monitoring sleep study. Spring. 2015;4:795.CrossRefGoogle Scholar
  94. 94.
    Pataka A, Daskalopoulou E, Kalamaras G, Fekete Passa K, Argyropoulou P. Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic. Sleep Med. 2014;15(7):776–81.CrossRefPubMedGoogle Scholar
  95. 95.
    Tan A, Hong Y, Tan LWL, van Dam RM, Cheung YY, Lee CH. Validation of NoSAS score for screening of sleep-disordered breathing in a multiethnic Asian population. Sleep Breath. 2017;21(4):1033–8.CrossRefPubMedGoogle Scholar
  96. 96.
    Guichard K, Marti-Soler H, Micoulaud-Franchi JA, Philip P, Marques-Vidal P, Vollenweider P, et al. The NoSAS score: a new and simple screening tool for obstructive sleep apnea syndrome in depressive disorder. J Affect Disord. 2018;227:136–40.CrossRefPubMedGoogle Scholar
  97. 97.
    Hong C, Chen R, Qing S, Kuang A, Yang H, Su X, et al. Validation of the NoSAS score for the screening of sleep-disordered breathing: a hospital-based retrospective study in China. J Clin Sleep Med. 2018;14(2):191–7.CrossRefPubMedGoogle Scholar
  98. 98.
    Duarte RL, Rabahi MF, Magalhães-da-Silveira FJ, Oliveira-e-Sá TS, Mello FC, Gozal D. Simplifying the screening of obstructive sleep apnea with a 2-item model, named “No-Apnea”: a cross-sectional study. J Clin Sleep Med 2018 (in press).Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ricardo Luiz de Menezes Duarte
    • 1
    • 2
  • Flavio José Magalhães-da-Silveira
    • 1
  • David Gozal
    • 3
  1. 1.Sleep - Laboratório de Estudo dos Distúrbios do SonoCentro Médico BarraShoppingRio de JaneiroBrazil
  2. 2.Instituto de Doenças do Tórax - Universidade Federal do Rio de JaneiroRio de JaneiroBrazil
  3. 3.Department of Pediatrics, Pritzker School of Medicine, Biological Sciences DivisionThe University of ChicagoChicagoUSA

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