Bianca Pivetta1, Lina Chen1, Mahesh Nagappa2, Aparna Saripella1, Rida Waseem1, Marina Englesakis3, Frances Chung1. 1. Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. 2. Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada. 3. Library and Information Services, University Health Network, Toronto, Ontario, Canada.
Abstract
Importance: Obstructive sleep apnea (OSA) is a highly prevalent global health concern and is associated with many adverse outcomes for patients. Objective: To evaluate the utility of the STOP-Bang (snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck size, gender) questionnaire in the sleep clinic setting to screen for and stratify the risk of OSA among populations from different geographical regions. Data Sources and Study Selection: MEDLINE, MEDLINE In-process, Embase, EmCare Nursing, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Journals@Ovid, Web of Science, Scopus, and CINAHL electronic databases were systematically searched from January 2008 to March 2020. This was done to identify studies that used the STOP-Bang questionnaire and polysomnography testing in adults referred to sleep clinics. Data Extraction and Synthesis: Clinical and demographic data were extracted from each article independently by 2 reviewers. The combined test characteristics were calculated using 2 × 2 contingency tables. Random-effects meta-analyses and metaregression with sensitivity analyses were performed. The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline was followed. Main Outcomes and Measures: The combined test characteristics and area under summary receiver operating characteristic curves (AUCs) were used to compare STOP-Bang questionnaire accuracy with polysomnography testing. Results: A total of 47 studies with 26 547 participants (mean [SD] age, 50 [5] years; mean [SD] body mass index, 32 [3]; 16 780 [65%] men) met the criteria for the systematic review. Studies were organized in different geographic regional groups: North America, South America, Europe, Middle East, East Asia, and South or Southeast Asia. The prevalence rates for all OSA, moderate to severe OSA, and severe OSA were 80% (95% CI, 80%-81%), 58% (95% CI, 58%-59%), and 39% (95% CI, 38%-39%), respectively. A STOP-Bang score of at least 3 had excellent sensitivity (>90%) and high discriminative power to exclude moderate to severe and severe OSA, with negative predictive values of 77% (95% CI, 75%-78%) and 91% (95% CI, 90%-92%), respectively. The diagnostic accuracy of a STOP-Bang score of at least 3 to detect moderate to severe OSA was high (>0.80) in all regions except East Asia (0.52; 95% CI, 0.48-0.56). Conclusions and Relevance: The results of this meta-analysis suggest that the STOP-Bang questionnaire can be used as a screening tool to assist in triaging patients with suspected OSA referred to sleep clinics in different global regions.
Importance: Obstructive sleep apnea (OSA) is a highly prevalent global health concern and is associated with many adverse outcomes for patients. Objective: To evaluate the utility of the STOP-Bang (snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck size, gender) questionnaire in the sleep clinic setting to screen for and stratify the risk of OSA among populations from different geographical regions. Data Sources and Study Selection: MEDLINE, MEDLINE In-process, Embase, EmCare Nursing, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Journals@Ovid, Web of Science, Scopus, and CINAHL electronic databases were systematically searched from January 2008 to March 2020. This was done to identify studies that used the STOP-Bang questionnaire and polysomnography testing in adults referred to sleep clinics. Data Extraction and Synthesis: Clinical and demographic data were extracted from each article independently by 2 reviewers. The combined test characteristics were calculated using 2 × 2 contingency tables. Random-effects meta-analyses and metaregression with sensitivity analyses were performed. The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline was followed. Main Outcomes and Measures: The combined test characteristics and area under summary receiver operating characteristic curves (AUCs) were used to compare STOP-Bang questionnaire accuracy with polysomnography testing. Results: A total of 47 studies with 26 547 participants (mean [SD] age, 50 [5] years; mean [SD] body mass index, 32 [3]; 16 780 [65%] men) met the criteria for the systematic review. Studies were organized in different geographic regional groups: North America, South America, Europe, Middle East, East Asia, and South or Southeast Asia. The prevalence rates for all OSA, moderate to severe OSA, and severe OSA were 80% (95% CI, 80%-81%), 58% (95% CI, 58%-59%), and 39% (95% CI, 38%-39%), respectively. A STOP-Bang score of at least 3 had excellent sensitivity (>90%) and high discriminative power to exclude moderate to severe and severe OSA, with negative predictive values of 77% (95% CI, 75%-78%) and 91% (95% CI, 90%-92%), respectively. The diagnostic accuracy of a STOP-Bang score of at least 3 to detect moderate to severe OSA was high (>0.80) in all regions except East Asia (0.52; 95% CI, 0.48-0.56). Conclusions and Relevance: The results of this meta-analysis suggest that the STOP-Bang questionnaire can be used as a screening tool to assist in triaging patients with suspected OSA referred to sleep clinics in different global regions.
Authors: Johannes B Reitsma; Afina S Glas; Anne W S Rutjes; Rob J P M Scholten; Patrick M Bossuyt; Aeilko H Zwinderman Journal: J Clin Epidemiol Date: 2005-10 Impact factor: 6.437
Authors: Asbjørn Kørvel-Hanquist; Ida Gillberg Andersen; Elisabeth Lauritzen; Susanne Dahlgaard; Janko Moritz Journal: Dan Med J Date: 2018-01 Impact factor: 1.240
Authors: Jin Mou; Bethann M Pflugeisen; Brian A Crick; Paul J Amoroso; Kirk T Harmon; Stephen F Tarnoczy; S Shirley Ho; Kimberly A Mebust Journal: Sleep Breath Date: 2018-04-24 Impact factor: 2.816
Authors: Jordy Mehawej; Jane S Saczynski; Catarina I Kiefe; Hawa O Abu; Mayra Tisminetzky; Weijia Wang; Benita A Bamgbade; Eric Ding; Darleen Lessard; Edith Mensah Otabil; Connor Saleeba; Robert J Goldberg; David D McManus Journal: J Clin Sleep Med Date: 2022-02-01 Impact factor: 4.324
Authors: Christopher N Schmickl; Naa-Oye Bosompra; Pamela N DeYoung; Dillon Gilbertson; Jeremy E Orr; Atul Malhotra; Igor Grant; Sonia Ancoli-Israel; Maile Karris Young; Robert L Owens Journal: J Clin Sleep Med Date: 2022-07-01 Impact factor: 4.324
Authors: Frances Chung; Rida Waseem; Chi Pham; Thomas Penzel; Fang Han; Bjørn Bjorvatn; Charles M Morin; Brigitte Holzinger; Colin A Espie; Christian Benedict; Jonathan Cedernaes; Tarja Saaresranta; Yun Kwok Wing; Michael R Nadorff; Yves Dauvilliers; Luigi De Gennaro; Guiseppe Plazzi; Ilona Merikanto; Kentaro Matsui; Damien Leger; Mariusz Sieminski; Sergio Mota-Rolim; Yuichi Inoue; Markku Partinen Journal: Sleep Breath Date: 2021-04-28 Impact factor: 2.816
Authors: Jean Wong; Helen R Doherty; Mandeep Singh; Stephen Choi; Naveed Siddiqui; David Lam; Nishanthi Liyanage; George Tomlinson; Frances Chung Journal: BMC Anesthesiol Date: 2022-09-14 Impact factor: 2.376
Authors: Salvatore Romano; Anna Lo Bue; Adriana Salvaggio; Luis V F Oliveira; Luigi Ferini-Strambi; Giuseppe Insalaco Journal: PLoS One Date: 2022-10-14 Impact factor: 3.752