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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:
    Objective measures:

    Result:

    Please fill out required fields.

    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.

    Formula

    Addition of the selected points (for the first four, ask the patient):

     

    0 points

    1 point

    Do you snore loudly? (Louder than talking or loud enough to be heard through closed doors)

    No

    Yes

    Do you often feel tired, fatigued, or sleepy during the daytime?

    No

    Yes

    Has anyone observed you stop breathing during sleep?

    No

    Yes

    Do you have (or are you being treated for) high blood pressure?

    No

    Yes

    BMI

    ≤35 kg/m2

    >35 kg/m2

    Age

    ≤50 years

    >50 years

    Neck circumference

    ≤40 cm

    >40 cm

    Gender

    Female

    Male

    Facts & Figures

    Interpretation:

    STOP-BANG

    Risk

    <3

    Low risk of OSA

    ≥3

    High risk of OSA

    Evidence Appraisal

    The STOP-BANG questionnaire was originally developed by Chung et al in 2008. The focus of this seminal paper is on the STOP questions in preoperative patients. However, appendix two is the STOP-BANG questionnaire which includes four objective assessments alongside of the four STOP questions. By including the BANG assessments with the STOP questions, the authors increased the sensitivity and negative predictive value of the screening test.  

    STOP-BANG has been studied and validated in multiple settings: 

    Xará 2015: High-risk OSA patients (>3 on STOP-BANG) have a greater incidence of postoperative respiratory complications including inability to breathe deeply and episodes of desaturation. 

    Uchôa 2015: OSA is independently associated with an increase in major adverse cardiac and cardiovascular events following coronary bypass graft surgery. 

    Tan 2016, Nagappa 2015: While initially developed for preoperative patients, STOP-BANG is an effective screen for the general population. 

    The STOP-BANG questionnaire has been translated to and validated in multiple languages including Arabic, Portuguese, Chinese, and Danish.

    Literature

    Dr. Frances Chung

    About the Creator

    Frances Chung, MBBS, LMCC, FRCPC, is a professor in the department of anesthesia at the University of Toronto, Canada. She is also a clinical researcher at the Krembil Research Institute and a senior staff anesthesiologist at the University Health Network-Mount Sinai Hospital. Dr. Chung’s research interests include obstructive sleep apnea as well as ambulatory and geriatric anesthesia.

    To view Dr. Frances Chung's publications, visit PubMed

    Content Contributors
    • Matthew J. Meyer, MD
    About the Creator
    Dr. Frances Chung
    Content Contributors
    • Matthew J. Meyer, MD