title: Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients.
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/m(2) were defined as obese patients and ≥ 35 kg/m(2) 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.
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, MCL 2-405, 399 Bathurst Street, Room 405, 2McL wing, Toronto, ON, M5T 2S8, Canada, Frances.Chung@uhn.ca.
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
authors.forename: Yiliang
authors.initials: Y
authors.lastname: Yang
authors.forename: Pu
authors.initials: P
authors.lastname: Liao
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D002170:Canada / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D009767:Obesity, Morbid / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D017286:Polysomnography / Q000379:methods; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012913:Snoring / Q000453:epidemiology; D011795:Surveys and Questionnaires