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    STOP-BANG Score for Obstructive Sleep Apnea

    Screens for obstructive sleep apnea.
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    INSTRUCTIONS

    Note: The STOP-BANG questionnaire screens for obstructive sleep apnea (OSA) only, not central sleep apnea.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients undergoing preoperative evaluation.
    • Unnecessary if a patient has already been diagnosed with OSA or uses CPAP at night.
    • Patients presenting to a clinic setting with symptoms associated with OSA like: daytime drowsiness, snoring, observed periods of nighttime apnea, noisy breathing, etc.

    The STOP-BANG questionnaire is not well-validated in the obstetrical population, a subgroup with increased risk of OSA.

    • The STOP-BANG questionnaire is one of the most widely accepted screening tools for OSA.
    • OSA (obstructive sleep apnea) is associated with increased risk of perioperative cardiopulmonary complications, including critical care admission.
    • Outside the perioperative setting, OSA has significant morbidity and may result in daytime sleepiness, neurocognitive deficiencies, and cardiopulmonary conditions.
    • Perioperative risks associated with OSA may be modifiable through increased monitoring and treatments (i.e., perioperative CPAP).
    Ask the patient the following:
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    Objective measures:
    ≤35 kg/m²
    0
    >35 kg/m²
    +1
    ≤50 years
    0
    >50 years
    +1
    ≤40 cm
    0
    >40 cm
    +1
    Female
    0
    Male
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Clinicians may opt to modify the care of patients who are high-risk for OSA:
      • Consider reducing narcotic medication doses.
      • Use caution when extubating “deep” or prior to return of airway reflexes.
      • Consider extended monitoring in PACU prior to discharge to an unmonitored floor.
      • Consider admission to a floor with increased level of monitoring or nursing supervision.
    • Patients should be counseled to bring their own CPAP machines to the hospital preoperatively if they have them.
    • PAP (positive airway pressure) machines should be available in the PACU (post anesthesia care unit) or on the floor for patients who are high-risk for OSA.
    • Following the perioperative period (or prior to if identified in a preoperative clinic), patients that screen as high-risk for OSA (obstructive sleep apnea) should have formal polysomnography to receive a definitive diagnosis.

    Management

    • OSA (obstructive sleep apnea) is due to a mechanical obstruction of the upper airway resulting in diminished breathing (hypopnea = narrowing) or elimination of breathing (apnea = collapse and obliteration).
    • The gold standard for OSA diagnosis is polysomnography.
    • CPAP (continuous positive airway pressure) is the first-line treatment of OSA and is very effective in stenting open the upper airway, but patient compliance is poor.
    Content Contributors
    • Matthew J. Meyer, MD
    About the Creator
    Dr. Frances Chung
    Are you Dr. Frances Chung?
    Teaching Resources
    Content Contributors
    • Matthew J. Meyer, MD