Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnoea in patients with cardiovascular risk factors: a systematic review and meta-analysis

Abstract

Introduction: Obstructive sleep apnoea (OSA) is highly prevalent in patients with cardiovascular risk factors and is associated with increased morbidity and mortality. This review presents the predictive parameters of the STOP-Bang questionnaire as a screening tool for OSA in this population.

Methods: A search of databases was performed. The inclusion criteria were: (1) use of the STOP-Bang questionnaire to screen for OSA in adults (>18 years) with cardiovascular risk factors; (2) polysomnography or home sleep apnoea testing performed as a reference standard; (3) OSA defined by either Apnoea-Hypopnoea Index (AHI) or Respiratory Disturbance Index; and (4) data on predictive parameters of the STOP-Bang questionnaire. A random-effects model was used to obtain pooled predictive parameters of the STOP-Bang questionnaire.

Results: The literature search resulted in 3888 articles, of which 9 papers met the inclusion criteria, involving 1894 patients. The average age of the included patients was 58±13 years with body mass index (BMI) of 30±6 kg/m², and 64% were male. The STOP-Bang questionnaire has a sensitivity of 89.1%, 90.7% and 93.9% to screen for all (AHI ≥5), moderate-to-severe (AHI ≥15) and severe (AHI≥30) OSA, respectively. The specificity was 32.3%, 22.5% and 18.3% and the area under the curve (AUC) was 0.86, 0.65 and 0.52 for all, moderate-to-severe and severe OSA, respectively.

Conclusion: The STOP-Bang questionnaire is an effective tool to screen for OSA (AHI≥5) with AUC of 0.86 in patients with cardiovascular risk factors.

Keywords: sleep apnoea.

Figure 1

PRISMA study flow. AHI, apnoea-hypopnea index; OSA, obstructive sleep apnoea; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses.

Figure 2

Forest plots for pooled sensitivity and specificity of STOP-Bang questionnaire for various OSA severities in patients with cardiovascular risk factors. Values are presented as means with 95% CI in parentheses. AHI, Apnoea–Hypopnea index; Bang, BMI, age, neck circumference and gender; OSA, obstructive sleep apnoea; STOP, snoring, tiredness, observed apnoea and high blood pressure.

Figure 3

Forest plot for pooled diagnostic OR for various OSA severities for patients with cardiovascular risk factors. Values are presented as means with 95% CI in parentheses. AHI, Apnoea–Hypopnea index; OSA, obstructive sleep apnoea.