Predicting obstructive sleep apnea using the STOP-Bang questionnaire in the general population

Sleep Med. 2016 Nov-Dec:27-28:66-71. doi: 10.1016/j.sleep.2016.06.034. Epub 2016 Oct 27.


Objective: The STOP-Bang questionnaire was developed as a quick and simple screening tool for obstructive sleep apnea (OSA) in preoperative clinics. We aimed to evaluate the validity of the STOP-Bang questionnaire to predict moderate-to-severe and severe OSA in the general population.

Methods: A sample of 242 subjects selected from a population-based cohort in Singapore completed home-based sleep testing with a type 3 monitor. Subjects were asked to complete the STOP questionnaire while body mass index (BMI), age, neck circumference, and sex were recorded. A score of ≥3 on the questionnaire indicated high risk of OSA.

Results: A total of 68 subjects (28.1%) and 26 subjects (10.7%) had an apnea-hypopnea index (AHI) of ≥15 and ≥30 events per hour, respectively. Of the subjects, 89 (36.8%) were classified as high risk based on the questionnaire. The sensitivity of a STOP-Bang score of ≥3 was 66.2% to detect AHI ≥15 and 69.2% to detect AHI ≥30. The specificities were 74.7% and 67.1%, respectively. The negative predictive values were 85% for moderate-to-severe OSA and 94.8% for severe OSA. The corresponding positive predictive values were 50.6% and 20.2%, respectively. Using BMI cutoffs of 30 and 27.5 for Asians compared to the original cutoff of 35 did not improve the questionnaire performance significantly.

Conclusion: The STOP-Bang questionnaire can be used as a screening tool in the general population in view of its moderate sensitivity and high negative predictive value for subjects with moderate-to-severe and severe OSA. The cutoff of BMI >35 can be used in Asians, as lower BMI cutoffs did not improve questionnaire performance.

Keywords: Body mass index; General population; Obstructive sleep apnea; STOP-Bang; Screening.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Age Factors
  • Body Mass Index
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Mass Screening*
  • Middle Aged
  • Neck / pathology
  • Organ Size
  • Prevalence
  • Prognosis
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Sex Factors
  • Singapore
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / epidemiology
  • Sleep Apnea, Obstructive / pathology
  • Snoring / diagnosis
  • Snoring / epidemiology
  • Snoring / pathology
  • Surveys and Questionnaires
  • Young Adult