Summary

Usage

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.

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Summary

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.

		0 Points	1 Point
S	Do you snore loudly? Louder than talking or loud enough to be heard through closed doors.	No	Yes
T	Do you often feel tired, fatigues, or sleepy during the daytime?	No	Yes
O	Has anyone observed you stop breathing during sleep?	No	Yes
P	Do you have (or are you being treated for) high blood pressure?	No	Yes
B	BMI	≤ 35 kg/m²	> 35 kg/m²
A	Age	≤ 50 years	> 50 years
N	Neck circumference	≤ 40 cm	> 40 cm
G	Gender	Female	Male

Results

STOP-BANG	Risk
0 - 2	Low risk for moderate to severe OSA
3 - 4	Intermediate risk for moderate to severe OSA
5 - 8	High risk for moderate to severe OSA

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.

STOP-BANG Score for Obstructive Sleep Apnea

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