STOP-Bang and pulse oximetry have shown efficacy as screening tools to identify individuals with sleep apnea, according to a study recently published in Anesthesia and Analgesia. 

This multicenter, prospective observational trial (ClinicalTrials.gov Identifier: NCT02293421) included 449 individuals who were referred for obstructive sleep apnea (OSA) evaluation at a sleep clinic. Participants in this study were evaluated using ambulatory polygraphy, which included both completion of the STOP-Bang questionnaire and pulse oximetry. Components of the STOP-Bang score include snoring, tiredness, observed apnea, high blood pressure, body mass index >35 kg/m2, age (>50 years), neck circumference (>40 cm), and male gender. The sum of these 8 factors produces the STOP-Bang score.

The threshold STOP-Bang score for moderate to severe sleep apnea was 6 (which correlated with apnea-hypopnea index (AHI) of ≥15, and this score had a sensitivity of 63% (95% CI, 0.55-0.70) and a specificity of 69% (95% CI, 0.64-0.75). The probability of a STOP-Bang score of <2, excluding AHI scores >15, was 95% (95% CI, 0.92-0.98), and there was a specificity of 91% for STOP-Bang scores of ≥6 to exclude AHIs >15 (95% CI, 0.87-0.94).


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The Bang items (body mass index, age, neck circumference, and male gender) were the most significant contributors to increasing the odds ratio of an AHI ≥15. In addition, there was a high correlation between AHI and oxygen desaturation index (Spearman ρ = 0.96; 95% CI, 0.94-0.97), and STOP-Bang and oxygen desaturation index, equal to that of AHI and STOP-Bang (Spearman ρ = 0.50; 95% CI, 0.43-0.58).

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The study researchers concluded, “STOP-Bang and pulse oximetry can be used to screen for sleep apnea. A STOP-Bang score of <2 almost excludes moderate and severe OSA, whereas nearly all the patients with a STOP-Bang score ≥6 have OSA. We suggest the addition of nightly pulse oximetry in patients with a STOP-Bang score of 2-5 when there is a need for screening for sleep apnea (ie, before surgery).”

Reference

Christensson E, Franklin KA, Sahlin C, et al. Can STOP-Bang and pulse oximetry detect and exclude obstructive sleep apnea [published online June 28, 2018]. Anesth Analg. doi: 10.1213/ANE.0000000000003607