STOP-Bang Sleep Apnea Screening Tool
|Answer each of the following yes or no:
1. Do you SNORE loudly (louder than talking or loud enough to be heard through closed doors)?
2. Do you often feel TIRED, fatigued, or sleepy during daytime?
3. Has anyone OBSERVED you stop breathing during your sleep?
4. Do you have or are you being treated for high blood PRESSURE?
5. BMI more than 35?
6. AGE over 50 years old?
7. NECK circumference > 15.75 inches?
8. Male GENDER?
≥3 yes answers: High-risk for OSA
<3 yes answers: Low-risk for OSA
Selected references from PubMed
A Screening Instrument for Sleep Apnea Predicts Airway Maneuvers in Patients Undergoing Advanced Endoscopic Procedures.
Coté GA, Hovis CE, Hovis RM, Waldbaum L, Early DS, Edmundowicz SA, Azar RR, Mullady DK, Jonnalagadda SS.
Clin Gastroenterol Hepatol. 2010 May 23. [Epub ahead of print]
Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri; Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana.
BACKGROUND & AIMS: Among patients undergoing advanced endoscopy, unrecognized obstructive sleep apnea (OSA) could predict sedation-related complications SRCs) and the need for airway maneuvers (AMs). By using an OSA screening tool, we sought to define the prevalence of patients at high risk for OSA and to correlate OSA with the frequency of AMs and SRCs. METHODS: We enrolled 231 consecutive patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) (n =176) and endoscopic ultrasound (n = 55). Propofol-based sedation and patient monitoring were performed by a nurse anesthetist and an anesthesiologist. A previously validated screening tool for OSA (STOP-BANG) was used to identify patients at high risk for OSA (score, >/=3 of 8; SB+) or low risk (SB-). AMs were defined as a chin lift, modified mask ventilation, nasal airway, bag-mask ventilation, and endotracheal intubation. SRCs were defined as any duration of pulse oximetry less than 90%, systolic blood pressure less than 90 mm Hg, apnea, or early procedure termination. RESULTS: The prevalence of SB+ was 43.3%. The frequency of hypoxemia was significantly higher among patients with SB+ than SB- (12.0% vs 5.2%; relative risk [RR], 1.83; 95% confidence interval [CI], 1.32-2.54). The rate of AMs was also significantly higher among SB+ (20.0%) compared with SB- (6.1%) patients (RR, 1.8; 95% CI, 1.3-2.4). These rates remained significant after adjusting for American Society of Anesthesiologists class 3 or higher (RR, 1.70; 95% CI, 1.28-2.2 for AMs; RR, 1.63; 95% CI, 1.19-2.25 for hypoxemia). Each element of the STOP-BANG was reported more commonly in SB+ patients (P < .0001 for each comparison). CONCLUSIONS: A significant number of patients undergoing advanced endoscopic procedures are at risk for OSA. AMs and hypoxemia occur at an increased frequency in these patients. Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.
PMID: 20580942 Obstructive sleep apnea (OSA) is a major risk factor for perioperative adverse events. However, no screening tool for OSA has been validated in surgical patients. This study was conducted to develop and validate a concise and easy-to-use questionnaire for OSA screening in surgical patients. METHODS: After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. After a factor analysis, reliability check, and pilot study; four yes/no questions were used to develop this screening tool. The four questions were respectively related to snoring, tiredness during daytime, observed apnea, and high blood pressure (STOP). For validation, the score from the STOP questionnaire was evaluated versus the apnea-hypopnea index from monitored polysomnography. RESULTS: The STOP questionnaire was given to 2,467 patients, 27.5% classified as being at high risk of OSA. Two hundred eleven patients underwent polysomnography, 34 for the pilot test and 177 for validation. In the validation group, the apnea-hypopnea index was 20 +/- 6. The sensitivities of the STOP questionnaire with apnea-hypopnea index greater than 5, greater than 15, and greater than 30 as cutoffs were 65.6, 74.3, and 79.5%, respectively. When incorporating body mass index, age, neck circumference, and gender into the STOP questionnaire, sensitivities were increased to 83.6, 92.9, and 100% with the same apnea-hypopnea index cutoffs. CONCLUSIONS: The STOP questionnaire is a concise and easy-to-use screening tool for OSA. It has been developed and validated in surgical patients at preoperative clinics. Combined with body mass index, age, neck size, and gender, it had a high sensitivity, especially for patients with moderate to severe OSA.
Screening for obstructive sleep apnea before surgery: why is it important?
Chung F, Elsaid H.
Curr Opin Anaesthesiol. 2009 Jun;22(3):405-11
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON M5T 2S8, Canada.
PURPOSE OF REVIEW: The purpose of this article is to review the screening tools available in the preoperative clinic for patients at risk of obstructive sleep apnea. RECENT FINDINGS: Obstructive sleep apnea (OSA) is the most prevalent sleep disorder. An estimated 82% of men and 92% of women with moderate-to-severe sleep apnea have not been diagnosed. Patients with undiagnosed OSA may have increased perioperative complications. The perioperative risk of patients with OSA may be reduced by appropriate screening to detect undiagnosed OSA in patients. The snoring (S), tiredness (T) during daytime, observed apnea (O), and high blood pressure (P) (STOP) questionnaire is a concise and easy-to-use screening tool to identify patients with a high risk of OSA. It has been validated in surgical patients at preoperative clinics as a screening tool. Incorporating BMI, age, neck size and gender into the STOP questionnaire (STOP-Bang), will further increase the sensitivity and negative predictive value (NPV), especially for patients with moderate-to-severe OSA. SUMMARY: The STOP questionnaire is short and can be easily incorporated into routine screening of general or surgical patients.
STOP questionnaire: a tool to screen patients for obstructive sleep apnea.
Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM.
Anesthesiology. 2008 May;108(5):812-21
Department of Psychiatry, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
|PubMed Search: STOP-Bang
August 19, 2010
1: Seet E, Chung F. Management of sleep apnea in adults - functional algorithms
for the perioperative period: Continuing Professional Development. Can J Anaesth.
2010 Aug 4. [Epub ahead of print] PubMed PMID: 20683690.
2: Coté GA, Hovis CE, Hovis RM, Waldbaum L, Early DS, Edmundowicz SA, Azar RR,
Mullady DK, Jonnalagadda SS. A screening instrument for sleep apnea predicts
airway maneuvers in patients undergoing advanced endoscopic procedures. Clin
Gastroenterol Hepatol. 2010 Aug;8(8):660-665.e1. Epub 2010 May 23. PubMed PMID:
3: Ong TH, Raudha S, Fook-Chong S, Lew N, Hsu AA. Erratum to: Simplifying
STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian
population. Sleep Breath. 2010 Jun 8. [Epub ahead of print] PubMed PMID:
4: Seet E, Chung F. Obstructive sleep apnea: preoperative assessment. Anesthesiol
Clin. 2010 Jun;28(2):199-215. PubMed PMID: 20488390.
5: 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
Apr 26. [Epub ahead of print] PubMed PMID: 20419474.
6: Abrishami A, Khajehdehi A, Chung F. A systematic review of screening
questionnaires for obstructive sleep apnea. Can J Anaesth. 2010 May;57(5):423-38.
Epub 2010 Feb 9. Review. PubMed PMID: 20143278.
7: Chung F, Elsaid H. Screening for obstructive sleep apnea before surgery: why
is it important? Curr Opin Anaesthesiol. 2009 Jun;22(3):405-11. Review. PubMed