Modified STOP-Bang questionnaire for detecting obstructive sleep apnea in individuals with a body mass index below 35 kg/m2

TL;DR

This study suggests modifying the STOP-Bang questionnaire to better detect sleep apnea in people with a BMI under 35.

Contribution

The study proposes revised cut-off values for age, BMI, and neck circumference in the STOP-Bang questionnaire for non-obese individuals.

Findings

Age ≥ 40 years, BMI ≥ 23 kg/m², and neck circumference ≥ 35 cm were optimal cut-offs for predicting OSA.

The modified STOP-Bang score had significantly higher sensitivity than the original for detecting OSA severity levels.

158 out of 188 patients in the study were diagnosed with obstructive sleep apnea.

Abstract

Obstructive sleep apnea (OSA) is a common clinical condition. Due to its high prevalence, the waiting list for polysomnography is often long. A screening tool is needed to identify individuals at high risk for OSA who should undergo polysomnography. The STOP-Bang questionnaire is a widely used screening tool; however, it may require modification for individuals with a body mass index (BMI) below 35 kg/m2. This study aimed to evaluate whether the STOP-Bang questionnaire should be modified for patients with a BMI under 35 kg/m2.

This retrospective analytical study included adult patients suspected of having OSA who underwent polysomnography. Exclusion criteria included pregnancy and a BMI over 35 kg/m2 or meeting criteria for bariatric surgery. Patients were categorized into OSA and non-OSA groups. Logistic regression analysis was used to assess the predictive value of STOP-Bang factors for OSA.

A total of 188 patients were included, of whom 158 (84.04%) were diagnosed with OSA. Among the eight STOP-Bang criteria, only age was independently associated with OSA after adjustment for other variables (adjusted odds ratio: 1.04; 95% CI [1.02–1.08]). Optimal cut-off points for predicting OSA were identified as age ≥ 40 years (sensitivity: 84.18%), BMI ≥ 23 kg/m2 (sensitivity: 82.91%), and neck circumference ≥ 35 cm (sensitivity: 86.08%). A modified STOP-Bang score incorporating these cut-offs showed improved sensitivity at a score of 3: 93.0% for apnea-hypopnea index (AHI) ≥ 5 events/hr, 95.9% for AHI ≥ 15 events/hr, and 97.6% for AHI ≥ 30 events/hr. In comparison, the original STOP-Bang score of 3 had sensitivities of 50.0%, 53.6%, and 56.1% for AHI ≥ 5 events/hr, AHI ≥ 15 events/hr, and AHI > 30 events/hr, respectively.

The STOP-Bang questionnaire may require modification for individuals with a BMI below 35 kg/m2 who are suspected of having OSA. Revised cut-off values for age, neck circumference, and BMI—40 years, 35 cm, and 23 kg/m2, respectively—may enhance its diagnostic performance.

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