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Using the STOPBANG questionnaire and other pre-test probability tools to predict OSA in younger, thinner patients referred to a sleep medicine clinic

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Background

The STOPBANG questionnaire is used to predict the presence of obstructive sleep apnea (OSA). We sought to assess the performance of the STOPBANG questionnaire in younger, thinner patients referred to a sleep medicine clinic.

Methods

We applied the STOPBANG questionnaire to patients referred for level I polysomnography (PSG) at our sleep center. We calculated likelihood ratios and area under the receiver operator characteristic (AUROC) curve and performed sensitivity analyses.

Results

We performed our analysis on 338 patients referred for PSG. Only 17.2% (n = 58) were above age 50 years, and 30.5 and 6.8% had a BMI above 30 and 35 years, respectively. The mean apnea-hypopnea index (AHI) was 12.9 ± 16.4 and 63.9% had an AHI ≥5. The STOPBANG (threshold ≥3) identified 83.1% of patients as high risk for an AHI ≥5, and sensitivity, specificity, positive (PPV), and negative predictive values (NPV) were 83.8, 18.0, 64.4, and 38.0%, respectively. Positive and negative likelihood ratios were poor at 1.02–1.11 and 0.55–0.90, respectively, across AHI thresholds (AHI ≥5, AHI ≥15 and AHI ≥30), and AUROCs were 0.52 (AHI ≥5) and 0.56 (AHI ≥15). Sensitivity analyses adjusting for insomnia, combat deployment, traumatic brain injury, post-traumatic stress disorder, clinically significant OSA (ESS >10 and/or co-morbid disease), and obesity did not significantly alter STOPBANG performance.

Conclusions

In a younger, thinner population with predominantly mild-to-moderate OSA, the STOPBANG Score does not accurately predict the presence of obstructive sleep apnea.

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Author information

Authors and Affiliations

  1. Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA

    Michael J. McMahon, Karen L. Sheikh, Teotimo F. Andrada & Aaron B. Holley

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  1. Michael J. McMahon
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  2. Karen L. Sheikh
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  3. Teotimo F. Andrada
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  4. Aaron B. Holley
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Contributions

Michael J. McMahon assisted with data collection, prepared all tables and figures, and performed the majority of the statistical analysis. He also contributed to writing and editing the manuscript.

Karen L. Sheikh contributed to data collection and data analysis and helped with editing and preparing the manuscript.

Teotimo F. Andrada assisted with data collection and database management.

Aaron B. Holley designed the study and contributed to database management and data analysis. He prepared the manuscript and vouches for the integrity of the data and accuracy of the analysis and conclusions.

Corresponding author

Correspondence to Aaron B. Holley.

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No funding was received for this research.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. The views expressed in this paper are those of the authors and do not communicate the official views of the Department of Defense. There was no off-label or investigational use of any products during this study. All work on this project was performed at the Walter Reed National Military Medical Center.

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McMahon, M.J., Sheikh, K.L., Andrada, T.F. et al. Using the STOPBANG questionnaire and other pre-test probability tools to predict OSA in younger, thinner patients referred to a sleep medicine clinic. Sleep Breath 21, 869–876 (2017). https://doi.org/10.1007/s11325-017-1498-1

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  • DOI: https://doi.org/10.1007/s11325-017-1498-1

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