- •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.
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.
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.
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).
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)
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Published online: February 11, 2020
Accepted: February 10, 2020
Received in revised form: January 21, 2020
Received: November 25, 2019
⋆Presented at the Sleep 2018 Annual Meeting, Baltimore, Maryland, June 2–6, 2018.
© 2020 Elsevier B.V. All rights reserved.