STOP-BANG Score for Obstructive Sleep Apnea
Screens for obstructive sleep apnea
Louder than talking or loud enough to be heard through closed doors.
Reference
Summary
Obstructive sleep apnea (OSA) is associated with significant morbidity, such as daytime sleepiness, neurocognitive deficiencies, cerebrovascular disease, diabetes and cardiopulmonary conditions (i.e. myocardial infarction and hypertension) (Chung, 2016). Additionally, OSA is linked to increased risk of perioperative cardiopulmonary complications, to include critical care admission. Perioperative risks associated with OSA can be modifiable through increase monitoring and treatments. The STOP-BANG questionnaire is a screening tool for patients undergoing preoperative evaluation to explore the presence of symptoms associated with OSA, such as daytime drowsiness, snoring, observed periods of nighttime apnea and noisy breathing. The tool is not intended for patients who have already been diagnosed with OSA or uses a continuous positive air pressure (CPAP) machine. STOP-BANG is not well-validated in the obstetrical population, a subgroup with increased risk of OSA.
.Summary
Chung et al (2008) includes four objective assessments (BANG - BMI, age, neck circumference and gender) along with the STOP questions to increase the sensitivity and negative predictive value of the screening test.
Formula
Sum of the selected points.
| 0 Points | 1 Point | ||
| S | Do you snore loudly? Louder than talking or loud enough to be heard through closed doors. | No | Yes |
| T | Do you often feel tired, fatigues, or sleepy during the daytime? | No | Yes |
| O | Has anyone observed you stop breathing during sleep? | No | Yes |
| P | Do you have (or are you being treated for) high blood pressure? | No | Yes |
| B | BMI | ≤ 35 kg/m² | > 35 kg/m² |
| A | Age | ≤ 50 years | > 50 years |
| N | Neck circumference | ≤ 40 cm | > 40 cm |
| G | Gender | Female | Male |
Results
| STOP-BANG | Risk |
| 0 - 2 | Low risk for moderate to severe OSA |
| 3 - 4 | Intermediate risk for moderate to severe OSA |
| 5 - 8 | High risk for moderate to severe OSA |
Management for High Risk Patients
Management
- The gold standard for OSA diagnosis is polysomnography.
- CPAP (continuous positive airway pressure) is the first-line treatment of OSA.
Perioperative Considerations
- Obtain a polysomnography (preoperative if possible) for a definitive diagnosis.
- Counsel patients to bring their own CPAP machines to the hospital preoperatively if they have them.
- Consider reducing narcotic medication dosage.
- Caution when extubating "deep" or prior to return of airway reflexes.
- Consider extended monitoring in PACU (post anesthesia care unit) prior to discharge to an unmonitored floor.
- PAP (positive airway pressure) machines should be available in the PACU or on the floor for patients who are high-risk for OSA.
- Consider admission to a floor with increased level of monitoring or nursing supervision.
Instructions
Not indicated for patients already diagnosed with obstructive sleep apnea (OSA) or using a continuous positive air pressure (CPAP) machine at night.
Literature
- STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008 May;108(5):812-21. — Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM.
- High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012 May;108(5):768-75. — Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y.
- 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 Dec 14;10(12):e0143697. — Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, Mokhlesi B, Chung F.
- STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest. 2016 March; 149(3): P631-638. — Chung F, Abdullah HR, Liao P.
- Jennifer Glen , DNP, FNP-BC — EVAL Health, Chief Medical Officer