Preoperative Screening for Obstructive Sleep Apnea Using Alternative Scoring Models of the Sleep Tiredness Observed Pressure-Body Mass Index Age Neck Circumference Gender Questionnaire: An External Validation

BACKGROUND: The Sleep Tiredness Observed Pressure-Body mass index Age Neck circumference Gender (STOP-Bang) questionnaire is a validated preoperative screening tool for identifying patients with obstructive sleep apnea (OSA). Although it has a high sensitivity at scores ≥3, its specificity is moderate, particularly for scores of 3–4. This study aimed to externally validate the STOP-Bang questionnaire and the alternative scoring models that have been proposed to improve its predictive performance. METHODS: This prospective cohort study included 115 surgical patients with preoperative STOP-Bang scores of 3–8. Type 3 sleep recordings identified moderate-to-severe OSA, reflected by an apnea–hypopnea index (AHI) of >15. Patients were categorized into 2 subgroups: patients with an intermediate (STOP-Bang 3–4) or a high risk of OSA (STOP-Bang 5–8). For patients with scores of 3–4, we tested approaches identified in previous studies: stepwise stratification of the STOP-Bang questionnaire and additional preoperative measurement of serum bicarbonate concentrations. RESULTS: The incidence of moderate-to-severe OSA was significantly higher in patients with STOP-Bang scores of 5–8 than in patients with scores of 3–4: 45 of 58 patients (78%) versus 30 of 57 patients (53%), respectively ( P < .01). For patients with STOP-Bang scores of 3–4, we found no differences regarding their OSA diagnosis between patients included in the alternative scoring models and those not included. CONCLUSIONS: The STOP-Bang questionnaire detected moderate-to-severe OSA patients when scores reached 5–8. However, its performance was altered in patients with STOP-Bang scores of 3–4, and alternative scoring models with specific combinations of factors failed to improve the screening of these patients.