Does the STOP-Bang, an obstructive sleep apnea screening tool, predict difficult intubation?

Eur Rev Med Pharmacol Sci. 2014 Jul;18(13):1869-74.


Objective: A close relationship between obstructive sleep apnea (OSA) and difficult intubation has been suggested. We hypothesized that the STOP-Bang questionnaire, a screening tool for obstructive sleep apnea (OSA), can predict difficult intubation.

Patients and methods: In this prospective cohort study, 200 adult surgical patients undergoing surgery under general anesthesia were studied to evaluate the usefulness of the STOP-Bang questionnaire for predicting difficult intubation. STOP-Bang questionnaire results, Mallampati score and tonsil size, as well as demographic data, were recorded preoperatively. Cormack & Lehane grading and difficulty of intubation (Cormack & Lehane grade III or IV, need of an intubation aid, or need of three or more intubation attempts) were also evaluated.

Results: Eighty-three out of 200 patients had a high risk of OSA based on the STOP-Bang questionnaire. The occurrence of difficult intubation was higher in the patients at a high risk of OSA (i.e., a STOP-Bang score of ≥ 3) than in the patients at a low risk (13.3% vs. 2.6%) (p = 0.004). Higher age, greater weight, higher body mass index, greater neck circumference, male gender, presence of comorbidities, lower preoperative SpO2, longer extubation times, higher Mallampati score, higher Cormack & Lehane grading, tonsil size and difficult intubation were significantly correlated with a high risk of OSA (p < 0.001). Fourteen out of 200 patients had difficulty in intubation. A STOP-Bang score of ≥ 3 was seen more frequently in the difficult intubation patients (78.6% vs. 38.7%) (p = 0.009). Greater weight, greater neck circumference, greater Mallampati score, a STOP-Bang score ≥ 3 and male gender were significantly correlated with difficult intubation (p < 0.05).

Conclusions: A STOP-Bang score of ≥ 3 was a predictor for difficult intubation.

MeSH terms

  • Adult
  • Age Factors
  • Body Mass Index
  • Body Weight
  • Female
  • Humans
  • Intubation, Intratracheal / adverse effects*
  • Male
  • Middle Aged
  • Neck / anatomy & histology
  • Organ Size
  • Palatine Tonsil / anatomy & histology
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Risk Factors
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / epidemiology
  • Surveys and Questionnaires*