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Identification of Patients with Sleep Disordered Breathing: Comparing the Four-Variable Screening Tool, STOP, STOP-Bang, and Epworth Sleepiness Scales

2011; American Academy of Sleep Medicine; Volume: 07; Issue: 05 Linguagem: Inglês

10.5664/jcsm.1308

1550-9397

Graciela E. Silva, Kimberly D. Vana, James L. Goodwin, Duane L. Sherrill, Stuart F. Quan,

Dysphagia Assessment and Management

Study Objective: The Epworth Sleepiness Scale (ESS) has been used to detect patients with potential sleep disordered breathing (SDB).Recently, a 4-Variable screening tool was proposed to identify patients with SDB, in addition to the STOP and STOP-Bang questionnaires.This study evaluated the abilities of the 4-Variable screening tool, STOP, STOP-Bang, and ESS questionnaires in identifying subjects at risk for SDB.Methods: A total of 4,770 participants who completed polysomnograms in the baseline evaluation of the Sleep Heart Health Study (SHHS) were included.Subjects with RDIs ≥ 15 and ≥ 30 were considered to have moderate-to-severe or severe SDB, respectively.Variables were constructed to approximate those in the questionnaires.The risk of SDB was calculated by the 4-Variable screening tool according to Takegami et al.The STOP and STOP-Bang questionnaires were evaluated including variables for snoring, tiredness/sleepiness, observed apnea, blood pressure, body mass index, age, neck circumference, and gender.Sleepiness was evaluated using the ESS questionnaire and scores were dichotomized into < 11 and ≥ 11. Results:The STOP-Bang questionnaire had higher sensitivity to predict moderate-to-severe (87.0%) and severe (70.4%)SDB, while the 4-Variable screening tool had higher specifi city to predict moderate-to-severe and severe SDB (93.2% for both).Conclusions: In community populations such as the SHHS, high specifi cities may be more useful in excluding low-risk patients, while avoiding false positives.However, sleep clinicians may prefer to use screening tools with high sensitivities, like the STOP-Bang, in order to avoid missing cases that may lead to adverse health consequences and increased healthcare costs.