The STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea in Pregnancy

Abstract

Study objectives: We examined the validity of the STOP-Bang questionnaire and a modified STOP-Bang questionnaire to screen for obstructive sleep apnea (OSA) in women with obesity during the second trimester of pregnancy.

Methods: Ninety-nine pregnant women age 18 years or older with body mass index ≥ 40 kg/m2 completed the STOP-Bang questionnaire during their second trimester. The number of oxygen desaturation events (≥ 4% from baseline) was measured using overnight pulse oximetry, with OSA defined as ≥ 5 events/h. A Modified STOP-Bang score was derived by replacing the "Tired" item with Epworth Sleepiness Scale score ≥ 10. Seven candidate models were compared using information theoretic criteria: STOP-Bang, Modified STOP-Bang, and individual STOP-Bang items (Snore, Tired, Observed to stop breathing, high blood Pressure and Neck circumference). We used penalized logistic regression and negative binomial regression to derive predicted probabilities of having OSA and the predicted total event counts.

Results: The predicted probability of meeting oximetry criteria for OSA increased with higher STOP-Bang scores, from < 10% for a score < 3 to 68% with a score of 6. The total number of disordered breathing events was 1.26 (95% confidence interval 1.06 to 1.50) times greater for a 1-unit increase in STOP-Bang. Of the candidate models, the best relative fit was the Snore item followed by STOP-Bang score (essentially equivalent). The predicted probability of having OSA was 5.0% for no snoring and 26.4% for snoring.

Conclusions: STOP-Bang has been shown to be a useful screening tool for OSA in pregnant women with obesity; however, the snoring question alone might be a simpler, effective predictor.

Clinical trial registration: Registry: ClinicalTrials.gov; Title: STOPBANG As A Screening Tool for Obstructive Sleep Apnoea in Pregnancy; URL: https://ichgcp.net/clinical-trials-registry/NCT02542488; Identifier: NCT02542488.

Keywords: OSA; STOP-Bang; obesity; pregnancy; sleep apnea; snoring.

© 2019 American Academy of Sleep Medicine.

Figures

Figure 1. STOP and modified STOP questions.