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Review
. 2017 Feb;30(1):118-125.
doi: 10.1097/ACO.0000000000000426.

An Update on the Various Practical Applications of the STOP-Bang Questionnaire in Anesthesia, Surgery, and Perioperative Medicine

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Free PMC article
Review

An Update on the Various Practical Applications of the STOP-Bang Questionnaire in Anesthesia, Surgery, and Perioperative Medicine

Mahesh Nagappa et al. Curr Opin Anaesthesiol. .
Free PMC article

Abstract

Purpose of review: The present review aims to provide an update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine.

Recent findings: The STOP-Bang questionnaire was originally validated as a screening tool to identify surgical patients who are at high-risk of obstructive sleep apnea (OSA). A recent meta-analysis confirmed that STOP-Bang is validated for use in the sleep clinic, surgical, and general population. Patients with a STOP-Bang score of 0--2 can be classified as low-risk for moderate-to-severe OSA. Those with a score of 5--8 can be classified as high-risk for moderate-to-severe OSA. In patients with a score of 3 or 4, a specific combination of a STOP score at least 2 + BMI more than 35 kg/m or STOP score at least 2 + male or STOP score at least 2 + neck circumference more than 40 cm indicates higher risk for moderate-to-severe OSA. Further, patients with a STOP-Bang score at least 3 can be classified as high risk for moderate-to-severe OSA if the serum HCO3 at least 28 mmol/l. STOP-Bang can be used as a novel tool for perioperative risk stratification because it easily identifies patients who are at increased risk of perioperative complications.

Summary: STOP-Bang at least 3 was recommended previously to identify the suspected or undiagnosed OSA. To reduce the false positive cases and to improve its specificity, a stepwise stratification is recommended to identify the patients at high risk of moderate-to-severe OSA. Because of its practical application, STOP-Bang is a useful screening tool for patients with suspected or undiagnosed OSA.

Figures

Box 1
Box 1
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FIGURE 1
FIGURE 1
Updated STOP-Bang questionnaire for screening OSA. In STOP-Bang, one point is scored for each positive answer. The total score ranges from 0 to 8. Patients can be classified for OSA risk based on their respective scores. Proprietary to University Health Network. Adapted with permission from [,,▪▪].
FIGURE 2
FIGURE 2
Probability of obstructive sleep apnea in surgical population. The relationship between STOP-Bang score and the probability of moderate-severe OSA (AHI ≥15) and severe OSA (AHI ≥30) in surgical patients. With a stepwise increase of the STOP-Bang score to 3, 4, 5, 6, and 7/8, the probability of moderate-to-severe (AHI ≥15) and severe OSA (AHI ≥30) increases proportionally. OSA, obstructive sleep apnea; SBQ, STOP-Bang questionnaire; Modified with permission from [▪▪].
FIGURE 3
FIGURE 3
Two-step strategy for using STOP-Bang questionnaire. The first step is to check the STOP-Bang score to divide the patients into one of the three category (low-risk, intermediate-risk, or high-risk for OSA). The second step is for patients with STOP-Bang score of 3 or 4 to identify those at high-risk of moderate-to-severe OSA. OSA, obstructive sleep apnea; SBQ, STOP-Bang questionnaire. Adapted with permission from [14].

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