Score Stop

[Giorgina Makara]

TheSTOP-Bang Questionnaire is a way that doctors can try to rapidly evaluate your risk of having obstructive sleep apnea (OSA). By asking questions about health issues related to the risk of developing sleep apnea, the STOP-Bang Questionnaire is designed to help detect whether you might have undiagnosed OSA.

However, the STOP-Bang Questionnaire cannot diagnose obstructive sleep apnea. Your doctor must order a sleep study to determine whether you have OSA. In addition, many experts have doubts about the accuracy of STOP-Bang scores. As a result, doctors tend to limit its use to specific situations.

The STOP-Bang Questionnaire is a tool that doctors can use to quickly assess your risk of having obstructive sleep apnea. It involves a series of eight yes-or-no questions. These questions, reflected in the STOP-Bang acronym, relate to known risk factors for OSA.

It is essential to note that the STOP-Bang score does not diagnose you with obstructive sleep apnea. Instead, the STOP-Bang Questionnaire may help your doctor determine if you need a sleep study to check for OSA. A sleep study can directly measure how often you have reductions in breathing during sleep, which is necessary for an OSA diagnosis.

There may also be variability in the accuracy of the STOP-Bang Questionnaire across different groups of people. For example, while the body mass index used in the questionnaire has been evaluated in people who are White, this may need to be adjusted in people with different backgrounds.

The Enhanced STOP-Bang Questionnaire involves adding a second step to the interpretation of scores of 3 or 4. In this modification, if a person answers yes to at least two of the STOP questions and at least one of the questions about body mass index, neck circumference, or male sex, then they are considered to have a high risk of obstructive sleep apnea.

The questions are straightforward, which means that the test is accessible to doctors who are not specialists in sleep medicine. Simple questions also make it easier for individuals to understand and respond to the survey.

In addition, while there are limitations to the overall accuracy of the STOP-Bang Questionnaire, doctors can generally be confident that people with very low scores do not have OSA. The questionnaire may also be helpful in specific medical situations, such as before a person has surgery.

Because of its limitations, the STOP-Bang Questionnaire is not a part of routine health care. Organizations of medical experts have reviewed the existing studies and determined that the STOP-Bang Questionnaire should not be broadly used in people who do not have symptoms of OSA.

People with OSA are more likely to experience complications when they have surgery. While a significant number of people who go in for surgery have OSA, many of them have not yet been diagnosed with the condition.

Because of its convenience, doctors can use the STOP-Bang Questionnaire to promptly identify individuals who may be at a higher risk of having OSA and related surgical complications. Many medical experts recommend that people preparing for surgery answer the eight questions needed to calculate their STOP-Bang scores.

Of these different tools, the STOP-Bang Questionnaire has been most well-validated in research studies. Nevertheless, none of these questionnaires or scores, including STOP-Bang, can diagnose obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a sleep disorder in which the airway is partially or completely blocked multiple times during the night, interfering with breathing. As it causes repetitive disruptions in breathing and sleep, OSA has been linked to a higher risk of heart attacks, diabetes, and other serious conditions, as well as ongoing tiredness.

The number of people with OSA is increasing, but many people do not realize they have the disorder, because symptoms primarily appear during sleep. Some researchers estimate that moderate to severe OSA may go undiagnosed and untreated in 80% of people with the condition. To identify people who may benefit from obstructive sleep apnea testing, researchers have developed a simple eight-question survey called the STOP-Bang Questionnaire.

The STOP-Bang Questionnaire is intended to give physicians an easy-to-use tool to identify people who might have obstructive sleep apnea. The questionnaire consists of eight yes-or-no questions based on the major risk factors for OSA. The name STOP-Bang is an acronym for the first letter of each symptom or physical attribute often associated with OSA:

When filling out the STOP-Bang questionnaire, a person receives one point for each symptom or risk factor, for a maximum of eight points. In general, the higher a person scores on the questionnaire, the greater risk they face of having moderate or severe OSA. Studies have also found that higher STOP-Bang scores are associated with more severe OSA Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source .

A STOP-Bang score of 2 or less is considered low risk, and a score of 5 or more is high risk for having either moderate or severe OSA. For people who score 3 or 4, doctors may need to perform further assessment to determine how likely they are to have OSA.

Doctors often use the STOP-Bang Questionnaire when they suspect a patient they are seeing might be at risk of having OSA. The STOP-Bang test can help doctors decide which people to prioritize for polysomnography, the sleep study used to diagnose OSA. First developed to screen for OSA in people about to undergo elective surgery Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source , the STOP-Bang Questionnaire has since been used for a wide variety of people and is considered an acceptable screening tool when used in sleep clinics or the general public.

Screening for OSA is important in a surgical context, because people with OSA have a higher risk of complications. For this reason, it is important that anesthesiologists and medical staff know if a person about to undergo surgery Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source has undiagnosed OSA, so they can provide additional care. An estimated 70% of people who undergo weight loss surgery have OSA. The STOP-Bang Questionnaire can identify people who need extra attention during and after surgery, so staff minimize the risks posed by surgery, anesthetic agents, and medications prescribed after surgery.

Independent researchers have found the STOP-Bang Questionnaire useful as a screen for OSA in adults with Down syndrome Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source , people with type 2 diabetes Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source , pregnant people with obesity Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source , and adults over 40 Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source . Findings from Brazilian Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source and Swedish Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source studies suggest that the questionnaire may be highly accurate for predicting OSA in people who receive specific scores, but less accurate for other scores.

In an analysis of over 100 research studies, researchers found that the STOP-Bang questionnaire could more accurately predict who has mild, moderate, and severe OSA Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source than three other questionnaire tools. The test may have a high rate for false positives, however, leading to unnecessary healthcare costs Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source if doctors send too many patients for sleep tests based on the STOP-Bang results. The accuracy of the test may vary depending on characteristics of the people taking it and whether they have any other conditions.

The STOP-Bang Questionnaire performs less well for certain groups of people, such as veterans and those with kidney failure. One of the items on the test, neck circumference, could turn out differently depending on how it is measured, which would also affect scores.

In the interest of keeping the test simple, each item is awarded an equal point, even though some of the risk factors are more significant than others. For example, a person with a high BMI or a thicker neck circumference is more likely to have OSA than someone who is merely older than 50 years. These details explain why the test is not perfect. However, the STOP-Bang test is a useful first step that may indicate whether it is worth conducting a more specific test.

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