Screening for obstructive sleep apnoea using the STOPBANG questionnaire

Editor – We read with interest the report by Isaac et al.1 in which they screened for obstructive sleep apnoea (OSA) in acute medical take patients, in particular their use of the STOPBANG questionnaire.2 We also have experience using this instrument, in the context of a cognitive disorders clinic based in a neurology centre,3 because of the possible contribution of OSA to symptoms of cognitive impairment.4
Our cohort of consecutive patients referred over a 3-month period with unexplained memory symptoms (n=67) was somewhat younger than that of Isaac et al (≤50 years of age: 12/67 = 18% vs 31/93 = 33%) and with a male preponderance (61% vs 43%). Nevertheless, using the STOPBANG score ≥3/8, the criterion for ‘suspected high risk of OSA’, around half of our patients screened positive (33/67 = 49% vs 73% in Isaac et al).
Evidently, STOPBANG is a highly sensitive test and therefore likely to detect prevalent cases of OSA, but in addition it will also identify large numbers of false positives; examination of the item content of STOPBANG shows that any tired male over 50 years of age will screen positive, ie score ≥3/8. Hence, as a stand-alone screen on which to base decisions about onward referral to services dedicated to diagnosis and treatment of OSA, use of STOPBANG might well prove overwhelming.3 We therefore endorse the idea of using a second screener, such as the Epworth sleepiness score (ESS), prior to initiating onward referral to OSA services in order to try to reduce the false positive rate.
- © Royal College of Physicians 2018. All rights reserved.
References
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- Isaac BTJ
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- Ziso B
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- Shastri A
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