Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic

Sleep Med. 2014 Jul;15(7):776-81. doi: 10.1016/j.sleep.2014.03.012. Epub 2014 Apr 20.


Background: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a major cause of morbidity and mortality. Different clinical models and questionnaires have been used to evaluate patients with the highest OSAHS probability.

Objectives: To evaluate the clinical utility of five different questionnaires--STOP, STOPBang (SB), Berlin Questionnaire (BQ), Epworth Sleepiness Scale (ESS), and 4-Variable Screening Tool (4-V) - in a sleep clinic in order to identify patients at risk for OSAHS and to assess the best possible combination of these tools.

Methods: 1853 (74.4% males) patients (mean age 52±14 years; mean body mass index 32.8±7 kg/m2) visiting a sleep clinic were studied retrospectively.

Results: SB had the highest sensitivity (97.6%), the largest area under the receiver operating characteristics curve (AUC) (0.73; 95% CI, 0.7-0.76) and best OR (5.9; 95% CI, 3.6-9.5), but the lowest specificity (12.7%) for AHI > or =15. The 4-V > or = 14 had the highest specificity (74.4%) followed by ESS (67%). BQ had good sensitivity (87%), worse specificity (33%) than 4-V and ESS but better than STOP (13%) and SB (12.7%). The combination of questionnaires did not improve their predictive value.

Conclusions: SB had the highest sensitivity, OR, and AUC, but rather low specificity, and 4-V the highest specificity. The combination of different questionnaires did not improve their predictive value.

Keywords: 4-Variable Screening Tool; Berlin Questionnaire; ESS; Evaluation; STOP; STOPBang.

Publication types

  • Evaluation Study

MeSH terms

  • Female
  • Humans
  • Male
  • Middle Aged
  • Polysomnography
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Sleep Apnea Syndromes / diagnosis*
  • Sleep Medicine Specialty / methods
  • Surveys and Questionnaires / standards