STOP-BANG Score for Obstructive Sleep Apnea

STOP-BANG Score for Obstructive Sleep Apnea

The STOP-BANG score is a validated screening tool for obstructive sleep apnea (OSA). It consists of 8 yes/no questions that assess symptoms and risk factors for OSA. The acronym represents the key components: Snoring, Tired, Observed, Pressure, BMI, Age, Neck circumference, and Gender.

STOP-BANG Criteria

The STOP-BANG score is calculated by assigning 1 point for each positive response:

STOP (Subjective Symptoms)

• S - Snoring: Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
• T - Tired: Do you often feel tired, fatigued, or sleepy during daytime?
• O - Observed: Has anyone observed you stop breathing during your sleep?
• P - Pressure: Do you have or are you being treated for high blood pressure?

BANG (Objective Measures)

• B - BMI: BMI >35 kg/m²
• A - Age: Age >50 years
• N - Neck circumference: Neck circumference >40 cm (16 inches)
• G - Gender: Male gender

Score Interpretation

Low Risk (0-2 points)

• Clinical significance: Low probability of moderate to severe OSA
• Prevalence: Low prevalence of moderate to severe OSA
• Management: Consider other causes of symptoms
• Follow-up: Routine care, monitor for new symptoms

Intermediate Risk (3-4 points)

• Clinical significance: Intermediate probability of moderate to severe OSA
• Prevalence: Moderate prevalence of moderate to severe OSA
• Management: Consider sleep study evaluation
• Follow-up: Monitor symptoms, consider referral to sleep specialist

High Risk (5-8 points)

• Clinical significance: High probability of moderate to severe OSA
• Prevalence: High prevalence of moderate to severe OSA
• Management: Recommend sleep study evaluation
• Follow-up: Refer to sleep specialist, consider CPAP evaluation

Clinical Applications

Screening Strategy

• Low risk (0-2): No further testing needed unless symptoms develop
• Intermediate risk (3-4): Consider home sleep study or in-lab polysomnography
• High risk (5-8): Recommend in-lab polysomnography
• Preoperative screening: Particularly important for surgical patients

Management Considerations

• Lifestyle modifications: Weight loss, positional therapy, alcohol avoidance
• CPAP therapy: First-line treatment for moderate to severe OSA
• Oral appliances: Alternative for mild to moderate OSA
• Surgical options: Consider for select patients

Important Considerations

Limitations

• Self-reported symptoms may be unreliable
• Does not replace formal sleep study
• May miss mild OSA cases
• Requires clinical judgment in addition to score
• Cultural and language barriers may affect accuracy

Special Populations

• Elderly patients: May have atypical presentations
• Women: May have different symptom patterns
• Children: Different criteria and evaluation needed
• Pregnant women: Consider pregnancy-related sleep changes

Clinical Pearls

• Always use clinical judgment in addition to the STOP-BANG score
• Consider comorbid conditions that may affect sleep
• Evaluate for other sleep disorders
• Monitor for cardiovascular complications
• Address modifiable risk factors
• Consider impact on quality of life and daily functioning
• Educate patients about OSA and treatment options

This calculator provides a validated method for screening patients for obstructive sleep apnea, helping to identify those who may benefit from further evaluation with sleep studies and appropriate treatment.