Sleep and Breathing

, Volume 23, Issue 1, pp 65–75 | Cite as

The discriminative power of STOP-Bang as a screening tool for suspected obstructive sleep apnea in clinically referred patients: considering gender differences

  • Jin MouEmail author
  • Bethann M. Pflugeisen
  • Brian A. Crick
  • Paul J. Amoroso
  • Kirk T. Harmon
  • Stephen F. Tarnoczy
  • S. Shirley Ho
  • Kimberly A. Mebust
Sleep Breathing Physiology and Disorders • Original Article



Obstructive sleep apnea (OSA) is the most commonly seen clinical sleep disorder. STOP-Bang, a widely used screening tool, yields a composite score based on eight dichotomized items including male gender. This study was designed to validate STOP-Bang among clinically referred patients and tested alternative scoring designs on tool performance, with a focus on gender differences in OSA.


STOP-Bang was administered to 403 female and 532 male subjects, followed by comprehensive sleep evaluation that included measurement of apnea-hypopnea indexes. Gender differences in STOP-Bang scores, OSA diagnosis, and severities were explored, and gender-specific alternative score cutoffs evaluated. Optimal operating points (OOP) were tested for female body mass index (BMI) and male neck circumference to inform STOP-Bang threshold refinement. Receiver operating characteristic curves were used to compare conventional and modified STOP-Bang.


STOP-Bang performance by gender showed extremely low specificity in males at the recommended cutoff of ≥3. Better utility was presented at a cutoff of 4 or 5 among clinically referred patients irrespective of gender differences. Screening performance was improved by modifying BMI and/or neck circumference thresholds using gender-triaged OOP estimation. Three gender-based model revisions outperformed conventional STOP-Bang.


Our study suggests that gender-specific consideration needs to be incorporated into the application of STOP-Bang in a clinically referred patient population with a higher risk of OSA. Alternative scoring systems may improve predictive performance of STOP-Bang.


Obstructive sleep apnea STOP-Bang Screening Gender disparity Sleep disorder 


Author contributions

J.M. helped design the study, implement statistical analysis, and write/revise the manuscript; B.M.P. set statistical analytical frameworks, wrote and did data management and statistics; B.A.C. and S.S.H. helped with study implementation, quality control, sleep study, writing up the sleep study methodology; P.J.A. and K.T.H. assisted with collaborative activities, study design, data collection, and manuscript revision; S.F.T. helped with writing and revision of the whole manuscript; K.A.M. was responsible for the whole study design, implementation, quality assurance of the sleep studies, and manuscript revision. K.A.M. is taking responsibility for the integrity of the work, from inception to publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

For this type of study (retrospective study), formal consent is not required. This study was evaluated by the MultiCare IRB and deemed to be a quality improvement project not requiring board review and approval.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jin Mou
    • 1
    Email author
  • Bethann M. Pflugeisen
    • 1
  • Brian A. Crick
    • 2
  • Paul J. Amoroso
    • 1
  • Kirk T. Harmon
    • 3
  • Stephen F. Tarnoczy
    • 4
  • S. Shirley Ho
    • 4
  • Kimberly A. Mebust
    • 4
  1. 1.MultiCare Institute for Research & InnovationMultiCare Health SystemTacomaUSA
  2. 2.Pulse Heart InstituteMultiCare Health SystemTacomaUSA
  3. 3.MultiCare Centers of Occupational MedicineFifeUSA
  4. 4.MultiCare Sleep Medicine CenterMultiCare Neuroscience Center of WashingtonTacomaUSA

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