Comparison of Epworth Sleepiness Scale and STOP-BANG Questionnaire for Diagnosing Obstructive Sleep Apnea at a Tertiary Care Centre in North India: A Retrospective Study

Abstract

Introduction:The diagnosis of obstructive sleep apnea (OSA) requires polysomnography (PSG). The screening of OSA utilizes questionnaires like the Epworth sleepiness scale (ESS) and the STOP-BANG questionnaire (SBQ) that have variable predictive value, as reported from the Western literature. Materials and methods: A retrospective cohort study was done in adult subjects (n = 80) presenting with symptoms of OSA. The demographic profile, ESS, and SBQ scores were evaluated. The level one recorded PSG was evaluated for apnea-hypopnea index (AHI) and positive airway pressure (PAP) therapy prescribed. Results: Of the 80 subjects, 75 were diagnosed as OSA on PSG. The mean age of the study group was 49 years, with 71% men and a mean BMI of 28.25 kg/m 2 . Epworth sleepiness scale ≥11 was in 62.66%, and SBQ ≥ 5 in 53% of the 75 subjects. Hence, both questionnaires failed to predict OSA in nearly half of the population. The mean AHI was 33.8/hour, and the mean continuous positive airway pressure (CPAP) was 10.05 cm H 2 O. The AHI had a significant correlation with BMI, ESS score, and CPAP. Epworth sleepiness scale had a 53% sensitivity and 60% specificity for diagnosing OSA using a cutoff of 11, whereas SBQ had a 68% sensitivity and 100% specificity using a cutoff of 5. Conclusion:The SBQ has a higher sensitivity and specificity to detect OSA than ESS as it envisages distinct clinical manifestations and risk factors of OSA. However, neither of the two can replace PSG.

Use and Performance of the STOP-Bang Questionnaire for Obstructive Sleep Apnea Screening Across Geographic Regions

“…Included studies showed low to moderate risk of bias after validity assessment and were used to answer our review question. Studies were organized into 6 groups: (1) North America (9 studies, [19][20][21][22][23][24][25][26][27] 3507 participants); (2) South America (6 studies, [28][29][30][31][32][33] 3) Europe (10 studies, [34][35][36][37][38][39][40][41][42][43] 5679 participants); (4) the Middle East (11 studies, [44][45][46][47][48][49][50][51][52][53][54] 3468 participants); (5) East Asia (4 studies, [55][56][57][58] 1665 participants); and (6) South or Southeast Asia (7 studies, [59][60][61][62][63][64]…”

“…Study characteristics and demographic data are summarized in Table 1 and eTable 3 in the Supplement, respectively . The initial search yielded 3871 studies, with 162 additional studies identified through citations (eFigure 1 in the Supplement).…”

“…Included studies showed low to moderate risk of bias after validity assessment and were used to answer our review question. Studies were organized into 6 groups: (1) North America (9 studies, 3507 participants); (2) South America (6 studies, 10 709 participants); (3) Europe (10 studies, 5679 participants); (4) the Middle East (11 studies, 3468 participants); (5) East Asia (4 studies, 1665 participants); and (6) South or Southeast Asia (7 studies, 1519 participants).…”

“…71 Changing the STOP-Bang BMI cutoff to 30, closer to the obesity cutoff for Asian populations, has shown increases in sensitivity without compromising specificity for OSA detection. 57,60,61 The craniofacial features are important in OSA pathogenesis and are unique depending on location. Chinese individuals have a smaller, narrower retropalatal airway and soft tissues with greater susceptibility to pharyngeal collapse.…”

“…This fat distribution pattern is associated with increased tongue size and lower lung volumes that may contribute to nocturnal upper airway collapse, such that Asians present with OSA at lower BMIs and are more sensitive to BMI increases . Changing the STOP-Bang BMI cutoff to 30, closer to the obesity cutoff for Asian populations, has shown increases in sensitivity without compromising specificity for OSA detection …”