Modified STOP-Bang questionnaire for detecting obstructive sleep apnea in individuals with a body mass index below 35 kg/m 2 .
Level 4 - case-series / case-control
Retrospective diagnostic accuracy and derivation study without external validation
PubMed 41244210 · doi:10.7717/peerj.20310
What was done
This retrospective analytical study evaluated 188 adult patients suspected of obstructive sleep apnea (OSA) who underwent polysomnography, excluding individuals who were pregnant, had a BMI > 35 kg/m², or met criteria for bariatric surgery. Multivariable logistic regression assessed the predictive value of STOP-Bang components to identify adjusted cut-off thresholds for age, BMI, and neck circumference, comparing the sensitivity of the modified tool to the standard questionnaire across different apnea-hypopnea index (AHI) severity levels.
What was found
Among 188 patients, 158 (84.04%) were diagnosed with OSA. Only age remained independently associated with OSA on multivariable analysis (adjusted OR 1.04, 95% CI [1.02–1.08]). Optimal cut-off thresholds were identified as age ≥ 40 years (sensitivity 84.18%), BMI ≥ 23 kg/m² (sensitivity 82.91%), and neck circumference ≥ 35 cm (sensitivity 86.08%). At a score threshold of 3, the modified STOP-Bang yielded higher sensitivity compared to the original questionnaire: 93.0% vs. 50.0% for AHI ≥ 5 events/hr, 95.9% vs. 53.6% for AHI ≥ 15 events/hr, and 97.6% vs. 56.1% for AHI ≥ 30 events/hr (original reported as AHI > 30).
Why it matters
Standard STOP-Bang cut-offs may lack sensitivity in non-severely obese individuals. Modifying anthropometric thresholds may improve screening yield for polysomnography referrals in populations with lower body mass index.
Limits
The study is a retrospective, single-cohort analysis with a modest sample size (n = 188) and high disease prevalence (84.04%). Thresholds were derived without an independent validation cohort, and specificity values were not reported in the abstract.
Cited by
- context A neck circumference greater than 17 inches for men or 16 inches for women is associated with a high likelihood of obstructive sleep apnea.