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BMI 35 kg/m2 does not fit everyone: a modified STOP-Bang questionnaire for sleep apnea screening in the Chinese population

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The STOP-Bang questionnaire is the most widely used to detect surgical patients at high risk of obstructive sleep apnea (OSA). However, the body mass index (BMI) cutoff value in the original STOP-Bang questionnaire is 35 kg/m2; the BMI in the Chinese population is lower than that. We aimed to establish a more appropriate BMI cutoff value in the STOP-Bang questionnaire for Chinese patients.


A total of 790 consecutive patients scheduled to undergo surgery at our hospital were included in this prospective study. All patients were asked to complete the STOP-Bang questionnaire and undergo a 7-h overnight polysomnography (PSG). The ability of STOP-Bang questionnaire to detect moderate to severe OSA (AHI ≥ 15 events/h) was assessed.


When the BMI cutoff value was set at 28 kg/m2, the questionnaire had the highest Youden index, although no significant differences were found in the sensitivity of the test compared with the original BMI cutoff in total and in male patients. In females, changing the BMI cutoff value from 35 to 28 kg/m2 resulted in the sensitivity of the test significantly increasing from 79.2% (74.9–83.5) to 89.3% (84.4–94.1), while the decrease in specificity was minor (from 43.6% [41.2–46.0] to 38.2% [36.1–40.3]), and the Youden index was highest (0.27) at this cutoff value. When the STOP-Bang questionnaire score was 4, the highest Youden index was obtained.


We recommend using a BMI cutoff value (28 kg/m2), and a STOP-Bang score ≥ 4 allows the anesthetist to identify patients with high risk of OSA.

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Obstructive sleep apnea


Body mass index




Neck circumference


Apnea-Hypopnea Index


Positive predictive value


Negative predictive value


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The authors would like to thank all of the physicians and participants of the study for their cooperation and generous participation.

Sources of funding

This study was supported by grants from Postdoctoral Foundation of Xuzhou Medical University, China (Grants Number 53470332, 2016).

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Authors and Affiliations



M.X. conceived and designed the study. J. X, M.X., Z.Z., and J.T. contributed to the data extraction, performed the analysis, and interpreted the results. M.X. wrote the first draft; N.J., D.Q, J.X., Z.Z., J.T., and Y.Z contributed to the revision of the final report. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ming Xia.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information


While this paper presents conclusions for a specific population, one of the main messages contained within is the requirement that the clinician consider the individuality of the patient they are treating. Precision medicine extends from the therapy decision all the way back to the identification of the population at risk. The tools we rely on to triage the people we see for potential medical therapy are not universal. These authors give us a clear example of why.

Steve Carstensen


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Xia, M., Liu, S., Ji, N. et al. BMI 35 kg/m2 does not fit everyone: a modified STOP-Bang questionnaire for sleep apnea screening in the Chinese population. Sleep Breath 22, 1075–1082 (2018).

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