STOP - BANG

Patient name
Date

A. Please answer the following questions below to determine if you might be at risk of Sleep Apnea No (0) Yes (1)
Snoring ?
Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?
Tired ?
Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?
Observed ?
Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep ?
Pressure ?
Do you have or are being treated for High Blood Pressure ?
Body Mass Index more than 35 kg/m2 ?   Weight: kg    Height: cm    
This patient has BMI < 35. The STOP-BANG score may not be valid.  See Notes below.
Age older than 50 ?
Neck size large ? (Measured around Adams apple)
For male, is your shirt collar 17 inches / 43cm or larger?
For female, is your shirt collar 16 inches / 41cm or larger?
Gender = Male ?

STOP-Bang Score:

Score Risk Category Peri-operative Event % (OR) Risk of Obstructive Sleep Apnea (OSA) in Obese Pre-Op Patients
0 - 2 Normal Risk 6% (1) 100% Negative Predictive Value for severe OSA
3 Increased Risk 20% (4) Half of obese patients have moderate or severe OSA
4 - 5 Likely OSA 30% (5) About 2/3 of obese patients in this range have moderate or severe OSA
≥ 6 Likely severe OSA 40% (6) Half of obese patients in this range have severe OSA



Some considerations for appropriate patient selection and results interpretation:

  • Caution: The STOP-Bang has low specificity (30%) and low positive predictive values (10%) in the general population, when BMI under 35.
  • A score of 3 or higher is highly sensitive (90%) for OSA in obese pre-operative patients (68% prevalence) and sleep study patients (85% prevalence) but is not specific (50%).
  • Scores in pre-operative patients correlate with increased unexpected intra-operative and early post-operative adverse events. Study rates above may not reflect your population.
  • Neither STOP-Bang nor nocturnal oximetry are diagnostic for OSA. Avoid changing management with discordant results.
  • If the STOP-Bang is high in an obese patient a negative nocturnal oximetry will not reliably reassure.
  • Similarly a low risk patient should not get nocturnal oximetry as false positives are likely.
  1. Reference: Chung F, Yang Y, Liao P. Predictive Performance of the STOP-Bang Score for Identifying Obstructive Sleep Apnea in Obese Patients OBES SURG (2013) 23:2050-2057 DOI 10.1007/s11695-013-1006-z
  2. Reference: Nagappa M, Liao P, Wong J, et al. Validation of the STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea among Different Populations: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(12):e0143697. Published 2015 Dec 14. doi:10.1371/journal.pone.0143697
  3. Reference: Seet E, Chua M, Liaw CM. High STOP-BANG questionnaire scores predict intraoperative and early postoperative adverse events. Singapore Med J. 2015;56(4):212-6.


Subject:


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