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Erschienen in: Obesity Surgery 12/2013

01.12.2013 | Original Contributions

Predictive Performance of the STOP-Bang Score for Identifying Obstructive Sleep Apnea in Obese Patients

verfasst von: Frances Chung, Yiliang Yang, Pu Liao

Erschienen in: Obesity Surgery | Ausgabe 12/2013

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Abstract

Background

The loud Snoring, Tiredness, Observed apnea, high blood Pressure (STOP)-Body mass index (BMI), Age, Neck circumference, and gender (Bang) questionnaire is a validated screening tool for identifying obstructive sleep apnea in surgical patients. However, the predictive performance of the STOP-Bang score in obese and morbidly obese patients remains unknown.

Methods

Preoperative patients were approached for consent and were screened for obstructive sleep apnea (OSA) by the STOP questionnaire. Information concerning Bang was collected. Laboratory or portable polysomnography were performed in 667 patients. Patients with BMI of ≥30 kg/m2 were defined as obese patients and ≥35 kg/m2 as morbidly obese. The predictive parameters (sensitivity, specificity, and positive and negative predictive values) for the STOP-Bang score in obese and morbidly obese patients were analyzed.

Results

In 310 obese patients, a STOP-Bang score of 3 has high sensitivity of 90 % and high positive predictive value of 85 % for identifying obese patient with OSA. A STOP-Bang score of 4 had high sensitivity (87.5 %) and high negative predictive value (90.5 %) for identifying severe OSA, whereas a STOP-Bang score of 6 had high specificity (85.2 %) to identify severe OSA. The diagnostic odds ratio of a STOP-Bang score of 4 was 4.9 for identifying severe OSA. In 140 morbidly obese patients, a STOP-Bang score of 4 had high sensitivity (89.5 %) for identifying severe OSA.

Conclusions

The STOP-Bang score was validated in the obese and morbidly obese surgical patients. For identifying severe OSA, a STOP-Bang score of 4 has high sensitivity of 88 %. For confirming severe OSA, a score of 6 is more specific.
Literatur
1.
Zurück zum Zitat Young T, Hutton R, Finn L, et al. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med. 1996;156:2445–51.PubMedCrossRef Young T, Hutton R, Finn L, et al. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med. 1996;156:2445–51.PubMedCrossRef
2.
Zurück zum Zitat Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31:1079–85.PubMed Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31:1079–85.PubMed
3.
Zurück zum Zitat Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin Sleep Cohort. Sleep. 2008;31:1071–8.PubMed Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin Sleep Cohort. Sleep. 2008;31:1071–8.PubMed
4.
Zurück zum Zitat Kaw R, Chung F, Pasupuleti V, et al. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109:897–906.PubMedCrossRef Kaw R, Chung F, Pasupuleti V, et al. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109:897–906.PubMedCrossRef
5.
Zurück zum Zitat Liao P, Yegneswaran B, Vairavanathan S, et al. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anesth. 2009;56:819–28.PubMedCrossRef Liao P, Yegneswaran B, Vairavanathan S, et al. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anesth. 2009;56:819–28.PubMedCrossRef
6.
Zurück zum Zitat Memtsoudis S, Liu SS, Ma Y, et al. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg. 2011;112:113–21.PubMedCrossRef Memtsoudis S, Liu SS, Ma Y, et al. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg. 2011;112:113–21.PubMedCrossRef
7.
Zurück zum Zitat Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20:705–6.PubMed Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20:705–6.PubMed
8.
Zurück zum Zitat Chung F, Yegneswaran B, Liao P, et al. Validation of Berlin Questionnaire and ASA Checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108:822–30.PubMedCrossRef Chung F, Yegneswaran B, Liao P, et al. Validation of Berlin Questionnaire and ASA Checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108:822–30.PubMedCrossRef
9.
Zurück zum Zitat Finkel KJ, Searleman AC, Tymkew H, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med. 2009;10:753–8.PubMedCrossRef Finkel KJ, Searleman AC, Tymkew H, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med. 2009;10:753–8.PubMedCrossRef
11.
Zurück zum Zitat Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.PubMedCrossRef Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.PubMedCrossRef
12.
Zurück zum Zitat Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217–39.PubMedCrossRef Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217–39.PubMedCrossRef
13.
Zurück zum Zitat Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83.PubMedCrossRef Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83.PubMedCrossRef
15.
Zurück zum Zitat Vgontzas AN, Tan TL, Bixler EO, et al. Sleep apnea and sleep disruption in obese patients. Arch Intern Med. 1994;154:1705–11.PubMedCrossRef Vgontzas AN, Tan TL, Bixler EO, et al. Sleep apnea and sleep disruption in obese patients. Arch Intern Med. 1994;154:1705–11.PubMedCrossRef
16.
Zurück zum Zitat Chung F, Yegneswaran B, Liao P, et al. STOP Questionnaire: a tool to screen obstructive sleep apnea. Anesthesiology. 2008;108:812–21.PubMedCrossRef Chung F, Yegneswaran B, Liao P, et al. STOP Questionnaire: a tool to screen obstructive sleep apnea. Anesthesiology. 2008;108:812–21.PubMedCrossRef
17.
Zurück zum Zitat Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108:768–75.PubMedCrossRef Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108:768–75.PubMedCrossRef
18.
Zurück zum Zitat Corso RM, Piraccini E, Agnoletti V, et al. Clinical use of the STOP-BANG questionnaire in patients undergoing sedation for endoscopic procedures. Minerva Anestesiol. 2012;78:109–10.PubMed Corso RM, Piraccini E, Agnoletti V, et al. Clinical use of the STOP-BANG questionnaire in patients undergoing sedation for endoscopic procedures. Minerva Anestesiol. 2012;78:109–10.PubMed
19.
Zurück zum Zitat Dias RA, Hardin KA, Rose H, et al. Sleepiness, fatigue, and risk of obstructive sleep apnea using the STOP-BANG questionnaire in multiple sclerosis: a pilot study. Sleep Breath. 2012;16:1255–65.PubMedCrossRef Dias RA, Hardin KA, Rose H, et al. Sleepiness, fatigue, and risk of obstructive sleep apnea using the STOP-BANG questionnaire in multiple sclerosis: a pilot study. Sleep Breath. 2012;16:1255–65.PubMedCrossRef
20.
Zurück zum Zitat Kurrek MM, Cobourn C, Wojtasik Z, et al. Morbidity in patients with or at high risk for obstructive sleep apnea after ambulatory laparoscopic gastric banding. Obes Surg. 2011;21:1494–8.PubMedCrossRef Kurrek MM, Cobourn C, Wojtasik Z, et al. Morbidity in patients with or at high risk for obstructive sleep apnea after ambulatory laparoscopic gastric banding. Obes Surg. 2011;21:1494–8.PubMedCrossRef
21.
Zurück zum Zitat McCormack DJ, Pabla R, Babu MH, et al. Undiagnosed sleep apnoea syndrome in patients with acute myocardial infarction: potential importance of the STOP-BANG screening tool for clinical practice. Int J Cardiol. 2012;155:342–3.PubMedCrossRef McCormack DJ, Pabla R, Babu MH, et al. Undiagnosed sleep apnoea syndrome in patients with acute myocardial infarction: potential importance of the STOP-BANG screening tool for clinical practice. Int J Cardiol. 2012;155:342–3.PubMedCrossRef
22.
Zurück zum Zitat Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89.
23.
Zurück zum Zitat Chung F, Liao P, Sun Y, et al. Perioperative practical experiences in using a level 2 portable polysomnography. Sleep Breath. 2010;15:367–75.PubMedCrossRef Chung F, Liao P, Sun Y, et al. Perioperative practical experiences in using a level 2 portable polysomnography. Sleep Breath. 2010;15:367–75.PubMedCrossRef
24.
Zurück zum Zitat Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Standards of Practice Committee of the American Sleep Disorders Association. Sleep. 1994;17:372–7. Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Standards of Practice Committee of the American Sleep Disorders Association. Sleep. 1994;17:372–7.
25.
Zurück zum Zitat Iber C, Ancoli-israel S, Cheeson A, et al. The AASM manual for the scoring of sleep and associated events, rules, terminology and technical specifications. Westchester, IL, USA: American Academy of Sleep Medicine; 2007. Iber C, Ancoli-israel S, Cheeson A, et al. The AASM manual for the scoring of sleep and associated events, rules, terminology and technical specifications. Westchester, IL, USA: American Academy of Sleep Medicine; 2007.
26.
Zurück zum Zitat Obuchowski NA. Sample size calculations in studies of test accuracy. Stat Methods Med Res. 1998;7:371–92.PubMedCrossRef Obuchowski NA. Sample size calculations in studies of test accuracy. Stat Methods Med Res. 1998;7:371–92.PubMedCrossRef
27.
Zurück zum Zitat Sareli AE, Cantor CR, Williams NN, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary center experience. Obes Surg. 2011;21:316–27.PubMedCrossRef Sareli AE, Cantor CR, Williams NN, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary center experience. Obes Surg. 2011;21:316–27.PubMedCrossRef
28.
Zurück zum Zitat Ray P, Le MY, Riou B, et al. Statistical evaluation of a biomarker. Anesthesiology. 2010;112:1023–40.PubMedCrossRef Ray P, Le MY, Riou B, et al. Statistical evaluation of a biomarker. Anesthesiology. 2010;112:1023–40.PubMedCrossRef
29.
Zurück zum Zitat Farney RJ, Walker BS, Farney RM, et al. The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the Apnea/Hypopnea Index. J Clin Sleep Med. 2011;7:459–65.PubMed Farney RJ, Walker BS, Farney RM, et al. The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the Apnea/Hypopnea Index. J Clin Sleep Med. 2011;7:459–65.PubMed
30.
Zurück zum Zitat Peppard PE, Young T, Palta M, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284:3015–21.PubMedCrossRef Peppard PE, Young T, Palta M, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284:3015–21.PubMedCrossRef
31.
Zurück zum Zitat Martinez-Rivera C, Abad J, Fiz JA, et al. Usefulness of truncal obesity indices as predictive factors for obstructive sleep apnea syndrome. Obesity. 2008;16:113–8.PubMedCrossRef Martinez-Rivera C, Abad J, Fiz JA, et al. Usefulness of truncal obesity indices as predictive factors for obstructive sleep apnea syndrome. Obesity. 2008;16:113–8.PubMedCrossRef
32.
Zurück zum Zitat Heinzer RC, Stanchina ML, Malhotra A, et al. Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea. Thorax. 2006;61:435–9.PubMedCrossRef Heinzer RC, Stanchina ML, Malhotra A, et al. Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea. Thorax. 2006;61:435–9.PubMedCrossRef
33.
Zurück zum Zitat Jordan AS, White DP, Owens RL, et al. The effect of increased genioglossus activity and end-expiratory lung volume on pharyngeal collapse. J Appl Physiol. 2010;109:469–75.PubMedCrossRef Jordan AS, White DP, Owens RL, et al. The effect of increased genioglossus activity and end-expiratory lung volume on pharyngeal collapse. J Appl Physiol. 2010;109:469–75.PubMedCrossRef
34.
Zurück zum Zitat Schwartz AR, Patil SP, Squier S, et al. Obesity and upper airway control during sleep. J Appl Physiol. 2010;108:430–5.PubMedCrossRef Schwartz AR, Patil SP, Squier S, et al. Obesity and upper airway control during sleep. J Appl Physiol. 2010;108:430–5.PubMedCrossRef
35.
Zurück zum Zitat Carneiro G, Florio RT, Zanella MT, et al. Is mandatory screening for obstructive sleep apnea with polysomnography in all severely obese patients indicated? Sleep Breath. 2012;16:163–8.PubMedCrossRef Carneiro G, Florio RT, Zanella MT, et al. Is mandatory screening for obstructive sleep apnea with polysomnography in all severely obese patients indicated? Sleep Breath. 2012;16:163–8.PubMedCrossRef
36.
Zurück zum Zitat Daltro C, Gregorio PB, Alves E, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17:809–14.PubMedCrossRef Daltro C, Gregorio PB, Alves E, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17:809–14.PubMedCrossRef
Metadaten
Titel
Predictive Performance of the STOP-Bang Score for Identifying Obstructive Sleep Apnea in Obese Patients
verfasst von
Frances Chung
Yiliang Yang
Pu Liao
Publikationsdatum
01.12.2013
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 12/2013
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-013-1006-z

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