title: Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth Sleepiness Scales.
abstract: 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 specificity to predict moderate-to-severe and severe SDB (93.2% for both).
  
  
  CONCLUSIONS
  In community populations such as the SHHS, high specificities 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.
authors: College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ 85004-0698, USA. graciela.silva@asu.edu
authors: Graciela E
authors: GE
authors: Silva
authors: Kimberly D
authors: KD
authors: Vana
authors: James L
authors: JL
authors: Goodwin
authors: Duane L
authors: DL
authors: Sherrill
authors: Stuart F
authors: SF
authors: Quan
mesh_terms: D001794:Blood Pressure; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012306:Risk; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*; D012913:Snoring / Q000175:diagnosis; D011795:Surveys and Questionnaires / Q000592:standards*