STOP-BANG questionnaire as a screening tool for diagnosis of obstructive sleep apnea by unattended portable monitoring sleep study

The Snoring, Tiredness, Observed apnea, high blood Pressure (STOP)-Body mass index (BMI), Age, Neck circumference, and Gender (BANG) questionnaire is a well validated screening tool for diagnosis of Obstructive sleep apnea (OSA) by an in- lab sleep study. However, performance of STOP-BANG as a screening tool for diagnosis of OSA in patients undergoing portable monitoring (PM) sleep study has not been well validated. We conducted a retrospective chart review of patients older than 18 years who had unattended portable monitoring sleep study done at a VA medical center between June 2012 and October 2014. STOP-BANG questionnaire and Epworth sleepiness scale (ESS) were routinely done prior to study. Sensitivity, specificity, and positive predictive value (PPV) various STOP-BANG score thresholds were calculated for diagnosis of OSA defined by Apnea Hypopnea Index (AHI) ≥5. Out of 502 unattended portable monitoring sleep studies, there were 465 males and 37 females. STOP-BANG thresholds of ≥2 and 3 have high sensitivity of 99.8 and 98.9 %, respectively, but very low specificity. Higher score thresholds of ≥7 and 8 have high specificity of 95 and 98.3 %, and PPV of 98.1 and 98.5 %, respectively, but very low sensitivity. A threshold of ≥7 in patients with BMI ≥30 was 100 % specific. The false negative rate for unattended portable monitoring sleep study compared to in-lab study was 80 %. STOP-BANG score thresholds of ≥7 and 8 are highly specific and have high PPV and therefore can potentially reduce need of diagnostic sleep studies in selected patients. Score thresholds of ≤2 or 3 are highly sensitive for AHI ≥5 by unattended portable monitoring sleep study but have high false negative rates. Therefore, in-lab sleep study should be performed to rule out OSA.