Title

STOP-Bang Questionnaire Is The Most Sensitive Questionnaire For Diagnosing Obstructive Sleep Apnea

Clinical Question

For an adult patient believed to have Obstructive Sleep Apnea, what is the best diagnostic method to pre-screen a patient for further testing?

Clinical Bottom Line

The STOP-Bang questionnaire is the most sensitive questionnaire for initiating an OSA diagnosis and further screening. This is supported by a meta-analysis and systematic review of several studies where the STOP-Bang questionnaire provided an extremely high sensitivity. The STOP-Bang questionnaire is recommended for an initial screening of OSA because of its ease of use and high sensitivity. (See Comments on the CAT below)

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
20143278	Abrishami/2010	10 studies	Systematic Review
Key results	The STOP-Bang questionnaire was found to have 1.00 sensitivity. This questionnaire had a specificity of 0.37, a Positive Predictive Value of 0.31, and a Negative Predictive Value of 1.00. Because it is used as an initial screening tool, sensitivity is more important for determining accuracy. This study was placed above the meta-analysis because it more accurately answered the clinical question.
19293704	Ramachandran/2009	26 studies	Meta-Analysis
Key results	The STOP-Bang questionnaire was found to have a sensitivity of 1.00, and a specificity of 0.364. While this information was in the article, the analysis created a statistic to measure the total accuracy of the test, placing equal value on sensitivity and specificity. Since the questionnaire is only an initial step of a diagnosis and not a diagnosis, specificity (related to false positives) is not of high importance. Even with a different focus, the STOP-Bang questionnaire was rated Average-Excellent in the different studies for predicting OSA.

Evidence Search

“Questionnaires”[Mesh] AND “Sleep Apnea, Obstructive/diagnosis” Filters: Meta-Analysis; Review

Comments on
The Evidence

Validity: In each of these studies, the STOP-Bang questionnaire was compared against a polysomnography to determine accuracy of results. Sensitivity was the most important statistic for this analysis because the questionnaire does not diagnose the patient but recommend patients at risk for further evaluation. Higher sensitivity minimizes the possibility of false negatives. While the specificity was low for the questionnaire (high number of false positives), it does not lead to a diagnosis but further evaluation. The questionnaire had a high sensitivity for mild, moderate, and severe OSA. Perspective: The STOP-Bang questionnaire is recommended as an initial screening step in diagnosing a patient with sleep apnea. Because of the high cost and wait time for a full polysomnography (PSG), there needs to be a step-wise diagnosis designed to minimize the amount of patients who undergo a PSG. The STOP-Bang questionnaire is a recommended initial screening step for an obstructive sleep apnea diagnosis. The surveyor should be aware that this is not a final diagnosis.

Applicability

A full polysomnography test is expensive and has a long wait list. The STOP-Bang questionnaire is extremely applicable as an initial screening tool because it is easy to administer and will suggest further testing if the patient is at risk. The STOP-Bang questionnaire should be used as the first test in a series of exams ultimately culminating in an overnight polysomnography (the gold standard) for diagnosing OSA.

Specialty

(Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Dental Hygiene)

Keywords

Obstructive Sleep Apnea, Diagnosis, Questionnaire

ID#

2344

Date of submission

03/07/2013

E-mail

shwarts@livemail.uthscsa.edu

Author

Ellis Shwarts

Co-author(s)

Melanie Taverna, RDH

Co-author(s) e-mail

TAVERNA@uthscsa.edu

Faculty mentor

Faculty mentor e-mail

Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

by Luis Yepes, Ju ri Hur, Megan Laughinghouse, Simone Janner (San Antonio, Texas) on 05/17/2013
There are newer systematic reviews that further support this CAT. Farney in 2011 (PMID 22003340 ) and Silva 2011 (PMID 22003341 ) Both articles support the Stop - Bang as the questionnaire with the highest sensitivity in detecting OSA. Particularly in patient without a history of sleep disorders having a moderate to high OSA (AHI>15). The Stop - Bang appears to be superior to the other analyzed questionnaires.

by Ann Larsen DDS, MS (San Antonio, TX) on 03/09/2013
A search of PubMed on 3-9-13 yielded a more recent systemic review that supports this CAT: PMID 22003341.