Highlights
- •The STOP-BANG questionnaire is a screening tool for obstructive sleep apnea (OSA).
- •Sex differences exist in the physiologic factors, symptoms, and severity of obstructive sleep apnea.
- •The STOP-BANG questionnaire for screening for obstructive sleep apnea has not been validated in women.
- •This screening questionnaire for obstructive sleep apnea needs different interpretation in women than men.
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.
Abbreviations:
AHI (apnea hypopnea index), AUC (area under the curve), BMI (body mass index), DREAMS (Data Registry on Experiences of Aging, Menopause, and Sexuality), HSAT (home sleep apnea test), NPV (negative predictive value), OR (odds ratio), OSA (obstructive sleep apnea), PAP (positive airway pressure), PPV (positive predictive value), PSG (polysomnography), REI (respiratory event index), STOP-BANG (snoring, tiredness, observed apneas, high blood pressure, body mass index, age, neck size, gender), WHC (Women’s Health Clinic)Keywords
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References
- Sleep apnea, hypopnea and oxygen desaturation in normal subjects: a strong male predominance.N. Engl. J. Med. 1979; 300: 513-517
- The gender bias in sleep apnea diagnosis: are women missed because they have different symptoms?.Arch. Intern. Med. 1996; 156: 2445-2451
- The occurrence of sleep-disordered breathing among middle-aged adults.N. Engl. J. Med. 1993; 328: 1230-1235
- Sex differences in sleep disordered breathing in adults.Respir. Physiol. Neurobiol. 2017; 245: 65-75
- Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study.Am. J. Respir. Crit. Care Med. 2003; 167: 1181-1185
- Association between obstructive sleep apnea syndrome and waist-to-height ratio.Sleep Breath. 2019; 23: 523-529
- Association between obesity and sleep disorders in postmenopausal women.Menopause. 2018; 25: 139-144
- Frequency of sleep disturbances in overweight/obese postmenopausal women.Rev. Bras. Ginecol. Obstet. 2014; 36: 90-96
- Gender differences in obstructive sleep apnea and treatment implications.Sleep Med. Rev. 2008; 12: 481-496
- Relationship between OSA and hypertension.Chest. 2015; 148: 824-832
- Obstructive sleep apnea and incident type 2 diabetes.Sleep Med. 2016; 25: 156-161
- Obstructive sleep apnea as a risk factor for stroke and death.N. Engl. J. Med. 2005; 353: 2034-2041
- Associations between sleep-disordered breathing, nocturnal hypoxemia, and subsequent cognitive decline in older community-dwelling men: the Osteoporotic Fractures in Men Sleep Study.J. Am. Geriatr. Soc. 2015; 63: 453-461
- Sex differences in the associations of obstructive sleep apnoea with epidemiological factors.Eur. Respir. J. 2018; 51
- Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women.Sleep. 1997; 20: 705-706
- Gender differences in the clinical manifestation of obstructive sleep apnea.Sleep Med. 2009; 10: 1075-1084
- Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome.Sleep. 2005; 28: 309-314
- STOP questionnaire: a tool to screen patients for obstructive sleep apnea.Anesthesiology. 2008; 108: 812-821
- Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis.Sleep Med. Rev. 2017; 36: 57-70
- Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic.Sleep Med. 2014; 15: 776-781
- Screening for obstructive sleep apnea among individuals with severe mental illness at a primary care clinic.Gen. Hosp. Psychiatry. 2012; 34: 660-664
- Predictive performance of the STOP-BANG score for identifying obstructive sleep apnea in obese patients.Obes. Surg. 2013; 23: 2050-2057
- Diagnostic accuracy of STOP-BANG questionnaire on moderate sleep apnoea in primary care.Gac. Sanit. 2019; 33: 421-426
- Validation of the STOP-BANG questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis.PLoS One. 2015; 10e0143697
- STOP-BANG questionnaire: a practical approach to screen for obstructive sleep apnea.Chest. 2016; 149: 631-638
- The discriminative power of STOP-BANG as a screening tool for suspected obstructive sleep apnea in clinically referred patients: considering gender differences.Sleep Breath. 2019; 23: 65-75
- Critical evaluation of screening questionnaires for obstructive sleep apnea in patients undergoing coronary artery bypass grafting and abdominal surgery.Sleep Breath. 2015; 19: 115-122
- The influence of gender on symptoms associated with obstructive sleep apnea.Sleep Breath. 2018; 22: 683-693
- Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients.Respir. Med. 2004; 98: 984-989
Article info
Publication history
Published online: February 11, 2020
Accepted:
February 10,
2020
Received in revised form:
January 21,
2020
Received:
November 25,
2019
Footnotes
⋆Presented at the Sleep 2018 Annual Meeting, Baltimore, Maryland, June 2–6, 2018.
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
