STOP-BANG Highly Predictive of Obstructive Sleep Apnea

A database analysis comprising more than 25,000 patients has concluded that the STOP-BANG questionnaire has cross-sectional construct validity, in that greater proportions of patients with intermediate and high STOP-BANG risk scores had known diagnoses of Obstructive Sleep Apnea (OSA).

STOP-BANG is the acronym for a series of questions on the following elements: snoring, tired, observed (i.e., stopped breathing or gasping during sleep), pressure (i.e., high blood pressure), body mass index (>35 kg/m²), age (>50 years), neck size and gender (i.e., male).

“The focus in perioperative medicine and respiratory conditions has recently shifted toward Obstructive Sleep Apnea, which poses the perioperative physician with interesting challenges, both in terms of diagnosis and management,” said Ashwin Sankar, MD, a resident at Mount Sinai Hospital at the University of Toronto. “Although there is some evidence of association between STOP-BANG scores with respiratory complications, there have been inconsistent associations between STOP-BANG and other non-respiratory outcomes.

“At our institution, we have been collecting STOP-BANG data prospectively since 2011,” he added. “So we set out to determine the validity of the STOP-BANG questionnaire.” Investigators conducted a retrospective cohort study of patients undergoing major, elective non-cardiac surgery at the institution between 2008 and 2015. Patients underwent a variety of surgical procedures with a median duration of two hours; most were performed under general anesthesia. STOP-BANG scores from the preoperative clinic were used to sort patients into low-, intermediate- or high-risk strata.

Validation for Sleep Apnea

The study cohort consisted of 26,068 patients. “With respect to STOP-BANG strata, low-risk patients were assigned scores of 0-2, intermediate risk scores were 3-4, and high risk was either 5 or greater or specific constellations of high-risk features,” Dr. Sankar explained.,This resulted in 15,126 patients (58%) at low, 6,056 patients (23%) at intermediate and 4,886 patients (19%) at high risk, according to STOP-BANG

Regarding the questionnaire’s cross-sectional construct validity, 4% (n=615) of the low-risk stratum had a known OSA diagnosis, compared with 12% (n=740) of the intermediate-risk stratum and 44% (n=2,142) of the high-risk stratum (Figure). “This suggests that the STOP-BANG questionnaire was doing what it’s supposed to,” Dr. Sankar said.

“In conclusion,” Dr. Sankar said, “the STOP-BANG questionnaire is clearly measuring what it’s supposed to measure, which is OSA. In fact, undiagnosed OSA was likely common in the intermediate- and high-risk STOP-BANG strata.

Sleep apnea is a serious disorder that can be life threatening. National Sleep Alliance can train you to work with a sleep apnea specialist so you can identify, treat and refer your patients as soon as possible to protect their health, and allow you to add medical billing revenues to grow your practice.

Source: Michael Vlessides. STOP-BANG Highly Predictive of Obstructive Sleep Apnea, but Shows Lower Predictive Validity Elsewhere. Anesthesiologynews.com