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Anesth Analg. 2018 Sep;127(3):736-743. doi: 10.1213/ANE.0000000000003607.

Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?

Author information

1
From the Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
2
Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
3
Departments of Surgical and Perioperative Sciences, Surgery.
4
Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
5
Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
6
Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
7
Sleep Apnea Clinic, Capio Läkargruppen, Örebro, Sweden.
8
Medical Statistics Unit, Department of Learning, Informatics, Managements and Ethics, Karolinska Institutet, Stockholm, Sweden.

Abstract

BACKGROUND:

Obstructive sleep apnea (OSA) is related to postoperative complications and is a common disorder. Most patients with sleep apnea are, however, undiagnosed, and there is a need for simple screening tools. We aimed to investigate whether STOP-Bang and oxygen desaturation index can identify subjects with OSA.

METHODS:

In this prospective, observational multicenter trial, 449 adult patients referred to a sleep clinic for evaluation of OSA were investigated with ambulatory polygraphy, including pulse oximetry and the STOP-Bang questionnaire in 4 Swedish centers. The STOP-Bang score is the sum of 8 positive answers to Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index >35 kg/m, Age >50 years, Neck circumference >40 cm, and male Gender.

RESULTS:

The optimal STOP-Bang cutoff score was 6 for moderate and severe sleep apnea, defined as apnea-hypopnea index (AHI) ≥15, and the sensitivity and specificity for this score were 63% (95% CI, 0.55-0.70) and 69% (95% CI, 0.64-0.75), respectively. A STOP-Bang score of <2 had a probability of 95% (95% CI, 0.92-0.98) to exclude an AHI >15 and a STOP-Bang score of ≥6 had a specificity of 91% (95% CI, 0.87-0.94) for an AHI >15. The items contributing most to the STOP-Bang were the Bang items. There was a positive correlation between AHI versus STOP-Bang and between AHI versus oxygen desaturation index, Spearman ρ 0.50 (95% CI, 0.43-0.58) and 0.96 (95% CI, 0.94-0.97), respectively.

CONCLUSIONS:

STOP-Bang and pulse oximetry can be used to screen for sleep apnea. A STOP-Bang score of <2 almost excludes moderate and severe OSA, whereas nearly all the patients with a STOP-Bang score ≥6 have OSA. We suggest the addition of nightly pulse oximetry in patients with a STOP-Bang score of 2-5 when there is a need for screening for sleep apnea (ie, before surgery).

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