Stop-bang questionnaire is a good test in discriminating OSA in obese women but no in men

Abstract

Recently, the STOP-Bang (SB) questionnaire was identified as a clinical screening tool for Obstructive Sleep Apnea (OSA) easy to use, and having a favorable diagnostic odds ratio, making it suitable for predicting severe OSA in the preoperative setting. OSA is considered a significant risk factor for perioperative morbidity and mortality. Our study explores the diagnostic test characteristics of SB against PSG in obese subjects, as it is recognized that obese are always at higher risk for surgical complications. Patients were recruited from the Sleep Clinic at INCMNSZ in Mexico City. The study was approved by the local ethics committee. To be included in the study, patients had to have a BMI ⩾ 30 kg/m 2 and to give their informed consent. Patients ( n = 214, Women = 134, men = 80), BMI women = 49.0 ± 8.9, Men = 47.6 ± 12.5; age women = 40.0 ± 11.5, men = 38.3 ± 12.5 were studied on two PSG consecutive nights. SB questionnaire was applied the night before first PSG. An AHI ⩾ 5 was considered positive diagnostic of OSA on PSG. We use Receiver operating characteristic curve (ROC) analysis to assess the diagnostic accuracy of the SB. We performed the ROC analysis by sex to see whether there were differences in accuracy. The diagnotic test’s discriminatory power at a cutoff of ⩾3 for men, and for women at ⩾2 cutoff were: Men, Area under the ROC Curve = 0.755, Standard Error = 0.06, p = 0.003, 95% CI = 0.640–0.870; Women, Area under the ROC Curve = 0.664, Standard error = 0.06, p = 0.003, 95% CI = 0.556–0.772. Sensitivity for Men = 0.909, Specificity = 0.857, FPR (1-Specificity) = 0.143, FNR (1-sensitivity) = 0.091; Sensitivity for Women = 0.990, Specificity = 0.842, FPR (1-Specificity) = 0.158, FNR (1-sensitivity) = 0.01. The diagnostic odds ratio (DOR) which combines data on sensitivity and specificity to give an indication of a test’s ability to rule in or rule out OSA condition were for Women = 17.9, for Men = 1.67. Stop-Bang questionnaire in obese patients seems to be a good test in discriminating OSA in obese women but with no value in prediction in obese men, as DOR value was <2. This work was supported by PAPIIT IN209109 and CONACYT-46257-H.