STOP-BANG Score for Obstructive Sleep Apnea
The STOP-BANG questionnaire is a validated screening tool for obstructive sleep apnea (OSA). It consists of 8 yes/no questions covering Snoring, Tiredness, Observed apnea, Pressure (hypertension), BMI >35, Age >50, Neck circumference >40cm, and Gender male.
About
The STOP-BANG score was developed by Dr. Frances Chung at the University of Toronto for perioperative OSA screening. It has been validated in surgical populations and the general population. A score of 0-2 indicates low OSA risk, 3-4 intermediate risk, and 5-8 high risk for moderate-to-severe OSA. The score has a sensitivity of 93.7% for detecting moderate-to-severe OSA at a cutoff of ≥3, and 84% at ≥5. The specificity at ≥5 is higher (92%), making it a useful two-step screening approach.
Formula
STOP-BANG = Snoring (1) + Tired (1) + Observed apnea (1) + Pressure/HTN (1) + BMI >35 (1) + Age >50 (1) + Neck circumference >40cm (1) + Male gender (1)
Each "yes" answer scores 1 point. S: Snoring loudly? T: Often feel tired during daytime? O: Observed stop breathing or choking/gasping? P: Treated for high blood pressure? B: BMI >35 kg/m²? A: Age >50? N: Neck circumference >40cm (measured at cricothyroid level)? G: Male gender? Total 0-8.
Score Interpretation
OSA affects 20-30% of the surgical population but is undiagnosed in 80% of cases. Untreated OSA increases perioperative risk of complications including difficult intubation, oxygen desaturation, cardiac arrhythmias, and postoperative respiratory failure. Pre-operative screening reduces adverse events.
Low Risk — 0–2
Low probability of moderate-to-severe OSA.
Management: No further OSA screening needed for most patients.
Intermediate Risk — 3–4
Intermediate probability of moderate-to-severe OSA.
Management: Consider polysomnography if clinical suspicion high.
High Risk — 5+
High probability of moderate-to-severe OSA.
Management: Polysomnography recommended. CPAP pre-operative optimization.
Reference Ranges
| Population | Normal Range |
|---|---|
| Pre-operative surgical patients | 0 (low risk) to 8 (high risk) |
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View medical review board & editorial policy →Example Calculation
A 55-year-old man with BMI 38, snoring, daytime sleepiness, observed apnea, and treated hypertension: STOP (S+T+O+P=4) + B+A+N+G (1+1+1+1=4) = 8/8. High risk for OSA.
Related Conditions
Common Mistakes
Not measuring neck circumference and relying on patient report only.
Neck circumference must be measured at the level of the cricothyroid membrane, not estimated.
Frequently Asked Questions
Does STOP-BANG change for pediatric patients?
References
- Chung F, et al. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016;149(3):631-8.