Identification of Patients with Sleep Disordered Breathing: Comparing the Four-Variable Screening Tool, STOP, STOP-Bang, and Epworth Sleepiness Scales

Abstract

Study Objective: The Epworth Sleepiness Scale (ESS) has been used to detect patients with potential sleep disordered breathing (SDB). Recently, a 4-Variable screening tool was proposed to identify patients with SDB, in addition to the STOP and STOP-Bang questionnaires. This study evaluated the abilities of the 4-Variable screening tool, STOP, STOP-Bang, and ESS questionnaires in identifying subjects at risk for SDB. Methods: A total of 4,770 participants who completed polysomnograms in the baseline evaluation of the Sleep Heart Health Study (SHHS) were included. Subjects with RDIs ≥ 15 and ≥ 30 were considered to have moderate-to-severe or severe SDB, respectively. Variables were constructed to approximate those in the questionnaires. The risk of SDB was calculated by the 4-Variable screening tool according to Takegami et al. The STOP and STOP-Bang questionnaires were evaluated including variables for snoring, tiredness/sleepiness, observed apnea, blood pressure, body mass index, age, neck circumference, and gender. Sleepiness was evaluated using the ESS questionnaire and scores were dichotomized into < 11 and ≥ 11. Results:The STOP-Bang questionnaire had higher sensitivity to predict moderate-to-severe (87.0%) and severe (70.4%) SDB, while the 4-Variable screening tool had higher specifi city to predict moderate-to-severe and severe SDB (93.2% for both). Conclusions:In community populations such as the SHHS, high specifi cities may be more useful in excluding low-risk patients, while avoiding false positives. However, sleep clinicians may prefer to use screening tools with high sensitivities, like the STOP-Bang, in order to avoid missing cases that may lead to adverse health consequences and increased healthcare costs. S C I E N T I f I C I N V E S T I g A T I O N SP rimary care providers frequently decide whether or not patients are referred for obstructive sleep apnea evaluations. Due to fi nancial constraints, this decision must be made quickly and accurately during short patient visits. Accurate screening for sleep disordered breathing (SDB) is necessary to properly identify at-risk patients. Several tools have been proposed to rapidly identify these patients. Anecdotally, the Epworth Sleepiness Scale (ESS) has been used by primary care providers to identify patients with potential sleep disorders. However, the ESS was developed to measure propensity for sleep onset rather than the likelihood of SDB.1,2 Takegami et al. 3 proposed a 4-Variable screening tool with high sensitivity (0.93) and high specifi city (0.66) for determining SDB severity. This scale utilizes gender, blood pressure (BP), body mass index (BMI), and snoring. In addition, the STOP and STOP-Bang questionnaires, 4,5 two simple 4-and 8-item tools, also have been used to screen for SDB. However, these tools have been validated in different populations and clinical settings with differing results, leaving the clinician to wonder which tool best screens for SDB. We aimed to investigate this question by comparing the results of these 4 tools, ut...

Home-based Diagnosis of Obstructive Sleep Apnea in an Urban Population

“…Other avenues to increase the specificity and positive likelihood ratio could be to test other screening questionnaires to identify an "at-risk" population and to examine other level 3 PM devices that use different technologies. [42][43][44] We found poor intra-individual agreement of simultaneous WatchPAT200 and PSG on aggregate overnight sleep parameters, as has been reported previously. 45 WatchPAT200 relies on actigraphy for TST estimation, which may be limited in populations with OSA.…”

The Prevalence of General Dentists Who Screen For Obstructive Sleep Apnea

“…The STOP-BANG questionnaire or Epworth Sleepiness Scale (ESS) are commonly used to gather information about factors such as tiredness, snoring, fatigue, blood pressure, and body mass index (BMI). 16 Both questionnaires have proved to be effective screening tools by deeming patients low to high risk and in predicting airway obstruction. 16 Although both questionnaires demonstrate significant positive association with OSA, it should be noted that the ESS has been shown to yield a weak significant correlation.…”

“…16 Both questionnaires have proved to be effective screening tools by deeming patients low to high risk and in predicting airway obstruction. 16 Although both questionnaires demonstrate significant positive association with OSA, it should be noted that the ESS has been shown to yield a weak significant correlation. 17 Second, closely related to the questionnaire, is an interview between patient and doctor.…”

STOP-BANG Questionnaire as a Screening Tool for Diagnosis of Obstructive Sleep Apnea by Unattended Portable Monitoring Sleep Study

“…The STOP-BANG questionnaire has been found to be equally effective in detecting OSA in community dwelling samples (Silva et al 2011), in patients referred to a sleep center for formal PSG (Farney et al 2011), and in patients in sleep clinics (Luo et al 2014). For all of these studies standard PSG was used for diagnosis of OSA (Chung et al 2008;Silva et al 2011;Farney et al 2011;Luo et al 2014). (Collop et al 2007).…”