Article Text

Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnoea in patients with cardiovascular risk factors: a systematic review and meta-analysis
  1. Mark Hwang1,
  2. Kevin Zhang2,
  3. Mahesh Nagappa3,
  4. Aparna Saripella4,
  5. Marina Englesakis5 and
  6. Frances Chung6
  1. 1Faculty of Medicine, Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Faculty of Medicine, Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Anaesthesia & Perioperative Medicine, London Health Sciences Centre, London, Ontario, Canada
  4. 4Department of Anaesthesia and Pain Medicine, University Health Network, Toronto, Ontario, Canada
  5. 5Library and Information Services, University Health Network, Toronto, Ontario, Canada
  6. 6Department of Anaesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Frances Chung; Frances.Chung{at}


Introduction Obstructive sleep apnoea (OSA) is highly prevalent in patients with cardiovascular risk factors and is associated with increased morbidity and mortality. This review presents the predictive parameters of the STOP-Bang questionnaire as a screening tool for OSA in this population.

Methods A search of databases was performed. The inclusion criteria were: (1) use of the STOP-Bang questionnaire to screen for OSA in adults (>18 years) with cardiovascular risk factors; (2) polysomnography or home sleep apnoea testing performed as a reference standard; (3) OSA defined by either Apnoea–Hypopnoea Index (AHI) or Respiratory Disturbance Index; and (4) data on predictive parameters of the STOP-Bang questionnaire. A random-effects model was used to obtain pooled predictive parameters of the STOP-Bang questionnaire.

Results The literature search resulted in 3888 articles, of which 9 papers met the inclusion criteria, involving 1894 patients. The average age of the included patients was 58±13 years with body mass index (BMI) of 30±6 kg/m2, and 64% were male. The STOP-Bang questionnaire has a sensitivity of 89.1%, 90.7% and 93.9% to screen for all (AHI ≥5), moderate-to-severe (AHI ≥15) and severe (AHI≥30) OSA, respectively. The specificity was 32.3%, 22.5% and 18.3% and the area under the curve (AUC) was 0.86, 0.65 and 0.52 for all, moderate-to-severe and severe OSA, respectively.

Conclusion The STOP-Bang questionnaire is an effective tool to screen for OSA (AHI≥5) with AUC of 0.86 in patients with cardiovascular risk factors.

  • sleep apnoea

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  • Contributors Study concept and design was performed by MH, MN and FC. Literature search was done by ME. Acquisition, analysis and interpretation of data were done by all the authors. Statistical analysis was performed by MH, KZ, MN and AS. Drafting of the manuscript was done by MH, KZ, MN and FC. All authors performed critical revision of the manuscript for important intellectual content. FC guarantees the integrity of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Author note The institution where the work was performed: University Health Network, University of Toronto, MCL 2-405, 399 Bathurst Street, Toronto, ON, Canada, M5T2S8.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.