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. 2020 May:135:1-5.
doi: 10.1016/j.maturitas.2020.02.004. Epub 2020 Feb 11.

Predictive ability and reliability of the STOP-BANG questionnaire in screening for obstructive sleep apnea in midlife women

Cinthya A Pena Orbea  1 , Robin M Lloyd  2 , Stephanie S Faubion  3 , Virginia M Miller  4 , Kristin C Mara  5 , Ekta Kapoor  6
Affiliations

Predictive ability and reliability of the STOP-BANG questionnaire in screening for obstructive sleep apnea in midlife women

Cinthya A Pena Orbea et al. Maturitas. 2020 May.

Abstract

Objectives: The STOP-BANG questionnaire (snoring, tiredness, observed apneas, high blood pressure, body mass index, age, neck size, gender) was originally validated to screen for obstructive sleep apnea (OSA) in the surgical population. It has been validated in mixed populations of men and women. We aimed to evaluate its reliability for OSA screening of midlife women.

Study design: We retrospectively evaluated midlife women seen at the Women's Health Clinic at Mayo Clinic in Rochester, Minnesota, who completed the STOP-BANG questionnaire and subsequently underwent diagnostic polysomnography (PSG) or home sleep apnea testing (HSAT).

Main outcome measures: The questionnaire's predictive ability was assessed with the apnea hypopnea index (AHI) measured at PSG and HSAT.

Results: Because participants were female, the gender question response was consistently 0, making the mean (SD) STOP-BANG score low at 3 (1.2). The most sensitive item to detect any OSA and moderate to severe OSA through STOP-BANG was observed apneas; the most specific item to detect OSA and moderate to severe OSA was neck circumference exceeding 40 cm. A score of 3 or more had a sensitivity of 77 % and a specificity of 45 % to detect moderate to severe OSA. The area under the curve with the STOP-BANG score to predict moderate to severe OSA was 0.67 (95 % CI, 0.51-0.84).

Conclusions: Interpretation of the STOP-BANG questionnaire is nuanced for midlife women. Given the nature of its questions, a lower score may be predictive of more severe OSA in women, necessitating use of a lower threshold to trigger further testing.

Keywords: Menopause; Obstructive sleep apnea; STOP-BANG; Women.

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Conflict of interest statement

Conflicts of interest: All authors have read and approved the final version of this manuscript. The authors listed above certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Conflict of interest

Stephanie S. Faubion is a consultant for AMAG Pharmaceutical, Inc; Mithra Pharmaceuticals; and Proctor & Gamble.

All other authors declare that they have no conflict of interest.

Figures

Figure.
Figure.
Receiver Operating Characteristic Curve of STOP-BANG Questionnaire Scores to Predict Moderate-to-Severe Obstructive Sleep Apnea of Midlife Women. AUC indicates area under the curve; STOP-BANG, snoring, tiredness, observed apneas, high blood pressure, body mass index, age, neck size, gender.
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References

    1. Block AJ, Boysen PG, Wynne JW, Hunt LA, Sleep apnea, hypopnea and oxygen desaturation in normal subjects: a strong male predominance, N Engl J Med 300(10) (1979) 513–7. - PubMed
    1. Young T, Hutton R, Finn L, Badr S, Palta M, The gender bias in sleep apnea diagnosis: are women missed because they have different symptoms?, Arch Intern Med 156(21) (1996) 2445–51. - PubMed
    1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S, The occurrence of sleep-disordered breathing among middle-aged adults, N Engl J Med 328(17) (1993) 1230–5. - PubMed
    1. Lozo T, Komnenov D, Badr MS, Mateika JH, Sex differences in sleep disordered breathing in adults, Respir Physiol Neurobiol 245 (2017) 65–75. - PubMed
    1. Young T, Finn L, Austin D, Peterson A, Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study, Am J Respir Crit Care Med 167(9) (2003) 1181–5. - PubMed