Pulmonology
STOP-BANG Score
Screen for obstructive sleep apnoea.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
STOP-BANG is an eight-item screening questionnaire for obstructive sleep apnoea (OSA), widely used in clinics and in preoperative assessment. The acronym covers Snoring, Tiredness, Observed apnoea, high blood Pressure, BMI over 35, Age over 50, Neck circumference over 40 cm and male sex (Gender). Each positive item scores one point, to a maximum of eight. It was developed to be quick and easy enough for routine use to flag patients who should undergo formal sleep assessment.
Interpreting the result
A score of 0–2 indicates low risk of OSA, 3–4 intermediate risk and 5–8 high risk, for which a sleep study should be considered. The questionnaire is sensitive but not specific, so it is good at not missing OSA but will flag some people who do not have it. A higher score, and particularly a high count combined with the more specific items, increases the probability of moderate-to-severe disease. It is a screen, not a diagnosis, which still requires sleep testing.
Worked example
A 55-year-old man with a BMI of 37 reports loud snoring, daytime tiredness and treated hypertension: snoring (1), tiredness (1), high blood pressure (1), BMI over 35 (1), age over 50 (1) and male sex (1) = 6. This is high risk, so referral for a sleep study is appropriate.
Pearls / pitfalls
- It is highly sensitive but not very specific, so a positive screen needs confirmatory sleep testing rather than treatment on its own.
- A low score is reassuring against moderate-to-severe OSA but does not completely exclude milder disease.
- In perioperative settings a high score should prompt heightened vigilance for airway and sedation risk.
- Self-reported items such as observed apnoea depend on a bed partner and may be missed in those who sleep alone.
Evidence & validation
Developed and validated by Chung and colleagues, initially in surgical patients, and shown in subsequent studies (summarised in Chest in 2016) to have high sensitivity for moderate-to-severe OSA; it is widely used in perioperative and sleep-medicine pathways.
Frequently asked questions
What STOP-BANG score means high risk of sleep apnoea?
A score of 5–8 indicates high risk of obstructive sleep apnoea and warrants consideration of a sleep study. A score of 3–4 is intermediate and 0–2 is low risk.
Is STOP-BANG diagnostic?
No. It is a screening tool with high sensitivity but limited specificity. A positive result identifies people who should undergo formal sleep testing, which is needed to confirm and grade OSA.
Why is it used before surgery?
Undiagnosed OSA increases perioperative airway and sedation risk. Because it is quick and sensitive, STOP-BANG helps anaesthetists identify patients needing extra caution and planning.
Does a low score rule out sleep apnoea?
A low score makes moderate-to-severe OSA much less likely but does not fully exclude milder disease. If symptoms are strongly suggestive, further assessment may still be appropriate.
What if there is no bed partner to report apnoea?
Items such as observed apnoea or choking rely on a witness. When someone sleeps alone these may be under-reported, so the score should be interpreted alongside the other items and the overall clinical picture.
References
- Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016;149(3):631–638.
- Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008.
About the creator
Chung F et al.
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