Skip to main content
SpringerLink
Log in

Real-world STOPBANG: how useful is STOPBANG for sleep clinics?

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

The STOPBANG questionnaire has been widely used for screening obstructive sleep apnea (OSA) due to its time friendly, economic advantages over overnight polysomnography (PSG). The aim of this study was to analyze the usefulness of the items constituting the utility of STOPBANG in a sleep clinic and to establish the best assembly for OSA-screening methods in the Korean population.

Methods

We retrospectively analyzed all patients who completed PSG as well as STOPBANG at a sleep center in a tertiary hospital from January 2016 to December 2017. The sensitivity and specificity of STOPBANG and its smaller counterparts (i.e., SOPBAG) were compared.

Results

A total of 541 subjects completed PSG and STOPBANG. Two hundred thirty-five patients were diagnosed with OSA (OSA+) and were compared to those who were not (OSA−). The respective scores of STOPBANG in OSA+ versus OSA− were 4.29 ± 1.46 and 2.53 ± 1.48 (p < 0.001). There were significant differences in all factors except tiredness and age (SOPBNG). STOPBANG showed sensitivity of 89.1% and specificity of 57.4%. The AUC was 0.809. Excluding tiredness as well as neck circumference (SOPBAG), the AUC was 0.811. The sensitivity and specificity were 71.8% and 77.9%, respectively. The AUC of SOPBAG was neither superior nor inferior to that of STOPBANG.

Conclusion

The screening value of STOPBANG for OSA did not perform as expected when compared to PSG for accuracy in Koreans. STOPBANG can be simplified to SOPBAG while maintaining comparable screening performance. It may be practical to consider performing PSGs without the use of the STOPBANG in Korea.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lee CH, Khoo SM, Tai BC, Chong EY, Lau C, Than Y, Shi DX, Lee LC, Kailasam A, Low AF, Teo SG, Tan HC (2009) Obstructive sleep apnea in patients admitted for acute myocardial infarction. Prevalence, predictors, and effect on microvascular perfusion. Chest 135(6):1488–1495

    Article  PubMed  Google Scholar 

  2. Senaratna CV, Perret JL, Lodge CJ et al (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81

    Article  PubMed  Google Scholar 

  3. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108(5):812–821

    Article  PubMed  Google Scholar 

  4. Chung F, Abdullah HR, Liao P (2016) STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest 149(3):631–638

    Article  PubMed  Google Scholar 

  5. Nahapetian R, Silva GE, Vana KD, Parthasarathy S, Quan SF (2016) Weighted STOP-Bang and screening for sleep-disordered breathing. Sleep Breath 20(2):597–603

    Article  PubMed  Google Scholar 

  6. Farney RJ, Walker BS, Farney RM et al (2011) 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 7(5):459–465b

    PubMed  PubMed Central  Google Scholar 

  7. Ong TH, Raudha S, Fook-Chong S, Lew N, Hsu AAL (2010) Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population. Sleep Breath 14(4):371–376

    Article  PubMed  Google Scholar 

  8. Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, Mokhlesi B, Chung F (2015) 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 10(12):e0143697

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kim B, Lee EM, Chung YS, Kim WS, Lee SA (2015) The utility of three screening questionnaires for obstructive sleep apnea in a sleep clinic setting. Yonsei Med J 56(3):684–690

    Article  PubMed  PubMed Central  Google Scholar 

  10. American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien, Illinois

  11. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the sleep apnea definitions task force of the American Academy of sleep medicine. J Clin Sleep Med 8(5):597–619

    PubMed  PubMed Central  Google Scholar 

  12. Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143(1):29–36

    Article  CAS  PubMed  Google Scholar 

  13. Pataka A, Daskalopoulou E, Kalamaras G, Fekete Passa K, Argyropoulou P (2014) Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic. Sleep Med 15(7):776–781

    Article  PubMed  Google Scholar 

  14. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491

    Article  CAS  PubMed  Google Scholar 

  15. Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y (2012) High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth 108(5):768–775

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545

    Article  CAS  PubMed  Google Scholar 

  17. Gamaldo C, Buenaver L, Chernyshev O, Derose S, Mehra R, Vana K, Walia HK, Gonzalez V, Gurubhagavatula I, OSA Assessment Tools Task Force of the American Academy of Sleep Medicine (2018) Evaluation of clinical tools to screen and assess for obstructive sleep apnea. J Clin Sleep Med 14:1239–1244

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tan A, Yin JD, Tan LW et al (2016) Predicting obstructive sleep apnea using the STOP-Bang questionnaire in the general population. Sleep Med 27–28:66–71

    Article  PubMed  Google Scholar 

  19. Ministry of Health and Welfare (2018) Notification 2018-135. National Health Insurance Act and its implementing ordinances Article 19 Protocol 1. https://www.hira.or.kr/rd/insuadtcrtr/bbsView.do?pgmid=HIRAA030069000400&brdScnBltNo=4&brdBltNo=51047&isPopupYn=Y. Accessed 1 Oct 2018

Download references

Acknowledgments

The authors wish to thank researcher Yeong Seon Lee for her work and polysomnography technicians Sang Hoon Jung, Kyung Woo Nam, and Ki Hwal Jung for their data collection.

Funding

This work was supported by the National Research Foundation of Korea grant funded by the Korean government (Ministry of Science and ICT) (No. 2017R1C1B5076728 and 2014R1A5A2010008).

Author information

Authors and Affiliations

  1. Department of Neurology, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea

    Keun Tae Kim & Yong Won Cho

Authors
  1. Keun Tae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yong Won Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Won Cho.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Keimyung University Dongsan Medical Center human ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

This study was approved by the institutional review board of a regional university hospital (#2018-03-030), and patient consent was exempt due to the retrospective nature of the study.

Additional information

Comments

This is a meaningful study of STOP-Bang, one of the most widely used questionnaire of OSA but rarely validated in Korean population.

Seong Min Oh

Seoul, Korea

Given the low specificity of the STOPBANG questionnaires, a more specific pre-test screening tool is warranted to make an early diagnosis of OSA in a cost-effective manner.

Yung-Che Chen

Taiwan

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, K.T., Cho, Y.W. Real-world STOPBANG: how useful is STOPBANG for sleep clinics?. Sleep Breath 23, 1219–1226 (2019). https://doi.org/10.1007/s11325-019-01806-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-019-01806-6

Keywords

Search

Navigation