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.
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.
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.
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.
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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.
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).
Conflict of interest
The authors declare that they have no conflicts of interest.
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.
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.
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
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.
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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
- Obstructive sleep apnea