Cutoff points in STOP-Bang questionnaire for obstructive sleep apnea

Jose Apolinário Silva NEVES JUNIOR; Ana Paula Andrade FERNANDES; Maria Angela TARDELLI; Américo Massafuni YAMASHITA; Sônia Maria Pereira Guimarães Togeiro MOURA; Sérgio TUFIK; Helga Cristina Almeida da SILVA

doi:10.1590/0004-282X20200086

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(09): 561-569
DOI: 10.1590/0004-282X20200086

ARTICLE

Cutoff points in STOP-Bang questionnaire for obstructive sleep apnea

Pontos de corte no STOP-Bang para apneia obstrutiva do sono

Jose Apolinário Silva NEVES JUNIOR

¹Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil.

,

Ana Paula Andrade FERNANDES

¹Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil.

,

Maria Angela TARDELLI

¹Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil.

,

Américo Massafuni YAMASHITA

¹Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil.

,

Sônia Maria Pereira Guimarães Togeiro MOURA

²Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Psychobiology, Sleep and Respiratory Divisions, São Paulo SP, Brazil.

,

Sérgio TUFIK

²Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Psychobiology, Sleep and Respiratory Divisions, São Paulo SP, Brazil.

,

Helga Cristina Almeida da SILVA

¹Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Surgery, Discipline of Anesthesiology, Pain and Intensive Care, São Paulo SP, Brazil.

› Author Affiliations

Abstract

ABSTRACT

Background: Obstructive Sleep Apnea Syndrome (OSAS) is a public health problem of high prevalence and impacts on quality of life, anesthetic complications and cardiovascular diseases. In view of the difficulty in accessing the polysomnography, it is necessary to validate other methods for OSAS diagnostic screening in clinical practice in our country, such as the STOP-Bang questionnaire. Objective: To validate the STOP-Bang questionnaire in Brazilians and evaluate optimal cutoff points. Methods: After translation and back-translation, STOP-Bang questionnaire was applied to 71 individuals previously submitted to polysomnography and classified into control, mild, moderate or severe OSAS. Results: The majority of patients was male (59.2%), white (79%), aged 48.9±13.9 years, and with neck circumference >40 centimeters (73.8%). STOP-Bang score was higher in OSAS mild (median/inter-quartis 25-75%: 5/3.5-6), moderate (4.5/4-5) and severe (5/4-6), versus control (2.5/1-4). The receiver operating characteristic (ROC) curve indicate that scores 3, 4 and 6, present the best specificity values (100, 80 and 92.9%) with acceptable sensitivity (60, 66.7 and 50%) in the mild, moderate and severe OSAS subgroups, respectively. In OSAS group analysis (Apnea Hypopnea Index [AHI] ≥5, <15, ≥15 - <30, ≥30), STOP-Bang cutoff point of 6 was optimal to detect OSAS. Conclusion: STOP-Bang Brazilian version identified OSAS patients with lower sensitivity and higher specificity compared to previous studies. Different cutoff points would improve the performance to detect patients with more severe OSAS.

RESUMO

Introdução: A Síndrome da Apneia Obstrutiva do Sono (SAOS) é um problema de saúde pública de alta prevalência e com impacto na qualidade de vida, complicações anestésicas e doenças cardiovasculares. Diante da dificuldade de acesso à realização da polissonografia, é necessário validar outros métodos para a triagem diagnóstica da SAOS na prática clínica no cenário brasileiro, como o questionário STOP-Bang. Objetivos: Validar o questionário STOP-Bang em brasileiros e avaliar os melhores pontos de corte. Método: Após tradução e retrotradução, o STOP-Bang foi aplicado em 71 indivíduos previamente submetidos à polissonografia e classificados em controles e em SAOS leve, moderada e grave. Resultados: A maioria da amostra foi de homens (59,2%), com 48,9±13,9 anos, brancos (79%) e com circunferência do pescoço >40 cm (73,8%). O escore STOP-Bang foi maior na SAOS leve (mediana/interquartis 25-75%: 5/3,5-6), moderada (4,5/4-5) e grave (5/4-6) versus controles (2,5/1-4). A Curva Característica de Operação do Receptor (ROC) indicou que os escores 3, 4 e 6 apresentam os melhores valores de especificidade (100, 80 e 92,9%) e sensibilidade aceitável (60, 66,7 e 50%) nos subgrupos de SAOS leve, moderada e grave, respectivamente. Na análise da amostra com SAOS (IAH ] ≥5, <15, ≥15 - <30, ≥30), o ponto de corte de 6 no STOP-Bang detectou melhor a SAOS. Conclusão: A versão brasileira do STOP-Bang identificou pacientes apneicos com menor sensibilidade e maior especificidade em relação a estudos anteriores. Diferentes pontos de corte melhorariam o desempenho para detectar pacientes com SAOS mais grave.

Keywords:

Obstructive Sleep Apnea - Polysomnography - Surveys and Questionnaires

Palavras-chave:

Apneia Obstrutiva do Sono - Polissonografia - Inquéritos e Questionários

Full Text

References

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