Validation of the STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea among Different Populations: A Systematic Review and Meta-Analysis

Mahesh Nagappa, Pu Liao, Jean Wong, Dennis Auckley, Satya Krishna Ramachandran, Stavros Memtsoudis, Babak Mokhlesi, Frances Chung, Mahesh Nagappa, Pu Liao, Jean Wong, Dennis Auckley, Satya Krishna Ramachandran, Stavros Memtsoudis, Babak Mokhlesi, Frances Chung

Abstract

Background: Diagnosing obstructive sleep apnea (OSA) is clinically relevant because untreated OSA has been associated with increased morbidity and mortality. The STOP-Bang questionnaire is a validated screening tool for OSA. We conducted a systematic review and meta-analysis to determine the effectiveness of STOP-Bang for screening patients suspected of having OSA and to predict its accuracy in determining the severity of OSA in the different populations.

Methods: A search of the literature databases was performed. Inclusion criteria were: 1) Studies that used STOP-Bang questionnaire as a screening tool for OSA in adult subjects (>18 years); 2) The accuracy of the STOP-Bang questionnaire was validated by polysomnography--the gold standard for diagnosing OSA; 3) OSA was clearly defined as apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) ≥ 5; 4) Publications in the English language. The quality of the studies were explicitly described and coded according to the Cochrane Methods group on the screening and diagnostic tests.

Results: Seventeen studies including 9,206 patients met criteria for the systematic review. In the sleep clinic population, the sensitivity was 90%, 94% and 96% to detect any OSA (AHI ≥ 5), moderate-to-severe OSA (AHI ≥15), and severe OSA (AHI ≥30) respectively. The corresponding NPV was 46%, 75% and 90%. A similar trend was found in the surgical population. In the sleep clinic population, the probability of severe OSA with a STOP-Bang score of 3 was 25%. With a stepwise increase of the STOP-Bang score to 4, 5, 6 and 7/8, the probability rose proportionally to 35%, 45%, 55% and 75%, respectively. In the surgical population, the probability of severe OSA with a STOP-Bang score of 3 was 15%. With a stepwise increase of the STOP-Bang score to 4, 5, 6 and 7/8, the probability increased to 25%, 35%, 45% and 65%, respectively.

Conclusion: This meta-analysis confirms the high performance of the STOP-Bang questionnaire in the sleep clinic and surgical population for screening of OSA. The higher the STOP-Bang score, the greater is the probability of moderate-to-severe OSA.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of screened, excluded…
Fig 1. Flow chart of screened, excluded and analyzed studies.
Fig 2. Flow chart for data collection…
Fig 2. Flow chart for data collection and grouping of the studies for systematic review and meta-analysis.
AHI: Apnea-Hypopnea Index; RDI: Respiratory Disturbance Index; n: number of participants.
Fig 3. Forest plot for pooled sensitivity…
Fig 3. Forest plot for pooled sensitivity and specificity for various OSA severities in Sleep Clinic populations.
TP—True Positive, FP—False Positive, FN—False Negative, TN—True Negative, CI—confidence Interval.
Fig 4. Forest plot for pooled Diagnostic…
Fig 4. Forest plot for pooled Diagnostic odds ratio for various OSA severities in Sleep Clinic populations.
OR—Odd Ratio, CI—Confidence Interval.
Fig 5. Forest plot for pooled sensitivity…
Fig 5. Forest plot for pooled sensitivity and specificity for various OSA severities in surgical populations.
TP—True Positive, FP—False Positive, FN—False Negative, TN—True Negative, CI—confidence Interval.
Fig 6. Forest plot for pooled Diagnostic…
Fig 6. Forest plot for pooled Diagnostic Odds Ratio for various OSA severities in Surgical populations.
OR—Odd Ratio, CI—Confidence Interval.
Fig 7. The relation between the various…
Fig 7. The relation between the various STOP-Bang scores and OSA probability.
OSA—obstructive sleep apnea, AHI—apnea-hypopnea index, SBQ—STOP-Bang Questionnaire.

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