STOP-BANG Score for Obstructive Sleep Apnea

Introduction

Obstructive sleep apnea (OSA) is associated with significant morbidity, such as daytime sleepiness, neurocognitive deficiencies, cerebrovascular disease, diabetes and cardiopulmonary conditions (i.e. myocardial infarction and hypertension) (Chung, 2016). Additionally, OSA is linked to increased risk of perioperative cardiopulmonary complications, to include critical care admission. Perioperative risks associated with OSA can be modifiable through increase monitoring and treatments. The STOP-BANG questionnaire is a screening tool for patients undergoing preoperative evaluation to explore the presence of symptoms associated with OSA, such as daytime drowsiness, snoring, observed periods of nighttime apnea and noisy breathing. The tool is not intended for patients who have already been diagnosed with OSA or uses a continuous positive air pressure (CPAP) machine. STOP-BANG is not well-validated in the obstetrical population, a subgroup with increased risk of OSA.

Chung et al (2008) includes four objective assessments (BANG - BMI, age, neck circumference and gender) along with the STOP questions to increase the sensitivity and negative predictive value of the screening test.

Formula

 Sum of the selected points.

Results

Management for High Risk Patients

Management

• The gold standard for OSA diagnosis is polysomnography.

• CPAP (continuous positive airway pressure) is the first-line treatment of OSA.

Perioperative Considerations

• Obtain a polysomnography (preoperative if possible) for a definitive diagnosis.

• Counsel patients to bring their own CPAP machines to the hospital preoperatively if they have them.

• Consider reducing narcotic medication dosage.

• Caution when extubating "deep" or prior to return of airway reflexes.

• Consider extended monitoring in PACU (post anesthesia care unit) prior to discharge to an unmonitored floor.

• PAP (positive airway pressure) machines should be available in the PACU or on the floor for patients who are high-risk for OSA.

• Consider admission to a floor with increased level of monitoring or nursing supervision.

Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008 May;108(5):812-21.