Indian Journal of Sleep Medicine

Register      Login

VOLUME 16 , ISSUE 3 ( July-September, 2021 ) > List of Articles


A Predictive Performance of STOP-BANG Score and Epworth Sleepiness Scale in Suspected Sleep Apnea Individuals

Nalin T Shah

Keywords : Apnea–Hypopnea Index, Epworth sleepiness scale, Obstructive sleep apnea, obese, gender and age, Snoring, STOP-BANG questionnaire

Citation Information : Shah NT. A Predictive Performance of STOP-BANG Score and Epworth Sleepiness Scale in Suspected Sleep Apnea Individuals. Indian Sleep Med 2021; 16 (3):69-76.

DOI: 10.5005/jp-journals-10069-0083

License: CC BY-NC 4.0

Published Online: 13-10-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Incidence of sleep apnea is rising globally. STOP-BANG (Snoring, Tiredness, Observed choking, Pressure, Body Mass Index (BMI), Age, Neck girth, Gender) Score and Epworth sleepiness scale (ESS) are outpatient assessment scores available to suspect and estimate the severity of obstructive sleep apnea (OSA) that is compared with gold standard test overnight polysomnography. Objective: The objective of the article was to validate and establish a correlation of variables of STOP-BANG Score, ESS, and Apnea–Hypopnea Index (AHI) from polysomnography. Methods: Retrospective study in patients aged 18 or more who were referred to the Department of Pulmonary Medicine, BJMC, Ahmedabad, between April 2017 and December 2020 who had complaints of excessive daytime sleepiness underwent overnight polysomnography after physical examination in the outpatient department. Results: Of our study population (n = 200), number of men were 137 (68.5%) and women were 63 (31.5%) with a male:female ratio of 2.17:1. Mean BMI, neck girth, ESS, STOP-BANG Score, and AHI were 32.78 ± 6.9 kg/m2, 39.49 ± 5.97 cm, 14.48 ± 3.91, 5.34 ± 1.7, and 48.22 ± 23, respectively, and the number of patients according to severity was mild 16 (8%), moderate 36 (18%), and severe 146 (73%). The Pearson correlation counted between neck girth (r = 0.68), ESS (r = 0.73) and STOP-BANG Score (r = 0.55) with AHI with a significant p value (<0.0001). Conclusion: Snoring is the most common symptom in suspected OSA individuals. The study showed a positive correlation of BMI, neck girth, ESS >10, STOP-BANG Score >3 with severity of OSA depicted in polysomnography.

  1. World Health Organization. Obesity and overweight. World Health Organization; 2017. Available from: http://wwwwhoint/news-room/fact-sheets/detail/obesity and overweight [Accessed on June 24, 2018].
  2. Available from:
  3. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet 2016;387(10026):1377–1396. DOI: 10.1016/S0140-6736(16)30054-X.
  4. Available from:
  5. Available from:
  6. Lugaresi E, Cirignotta F, Coccagna G, et al. Some epidemiological data on snoring and cardiocirculatory disturbances. Sleep 1980;3(3): 221–224. DOI: 10.1093/sleep/3.3-4.221.
  7. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328(17):1230–1235. DOI: 10.1056/NEJM199304293281704.
  8. Pevernagie D, Aarts RM, De Meyer M. The acoustics of snoring. Sleep Med Rev 2010;14(2):131–144. DOI: 10.1016/j.smrv.2009.06.002.
  9. Wilson K, Stoohs RA, Mulrooney TF, et al. The snoring spectrum: acoustic assessment of snoring sound intensity in 1,139 individuals undergoing polysomnography. Chest 1999;115(3):762–770. DOI: 10.1378/chest.115.3.762.
  10. Guilleminault C, Stoohs R, Duncan S. Snoring (I). Daytime sleepiness in regular heavy snorers. Chest 1991;99(1):40–48. DOI: 10.1378/chest.99.1.40.
  11. Dalmasso F, Prota R. Snoring: analysis, measurement, clinical implications and applications. Eur Respir J 1996;9(1):146–159. DOI: 10.1183/09031936.96.09010146.
  12. Thorpy MJ. Classification of sleep disorders. Neurotherapeutics 2012;9(4):687–701. DOI: 10.1007/s13311-012-0145-6.
  13. Shin C, Kim J, Kim J, et al. Association of habitual snoring with glucose and insulin metabolism in nonobese Korean adult men. Am J Respir Crit Care Med 2005;171(3):287–291. DOI: 10.1164/rccm.200407-906OC.
  14. Marchesini G, Pontiroli A, Salvioli G, et al. Snoring, hypertension and Type 2 diabetes in obesity. Protection by physical activity. J Endocrinol Invest 2004;27(2):150–157. DOI: 10.1007/BF03346260.
  15. Oliven A, Aspandiarov E, Gankin I, et al. Collapsibility of the relaxed pharynx and risk of sleep apnoea. Eur Respir J 2008;32:1309–1315. DOI: 10.1183/09031936.00139407.
  16. Peppard PE, Young T, Palta M, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284(23):3015–3021. DOI: 10.1001/jama.284.23.3015.
  17. Siegfried W, Siegfried A, Rabenbauer M, et al. Snoring and sleep apnea in obese adolescents: Effect of long-term weight loss-rehabilitation. Sleep Breath 1999;3:83–88. DOI: 10.1007/s11325-999-0083-7.
  18. Shukla AD, Jain S, Mishra R, et al. Does ‘weight reduction’ help all adult snorers? Lung India 2013;30(1):16–19. DOI: 10.4103/0970-2113.106123.
  19. Wickramasinghe H, Rowley J. Medscape – ACCP AASM.
  20. Silverberg DS, Oksenberg A. Are sleep related breathing disorder important contributing factors to the production of essential hypertension? Curr Hypertens Rep 2001;3(3):209–215. DOI: 10.1007/s11906-001-0040-8.
  21. Worsnop CJ, Naughton MT, Barter CE, et al. The prevalence of obstructive sleep apnea in hypertensives. Am J Respir Crit Care Med 1998;157(1):111–115. DOI: 10.1164/ajrccm.157.1.9609063.
  22. Block AJ, Boysen PG, Wynne JW, et al. Sleep apnea, hypopnea and oxygen desaturation in normal subjects: A strong male predominance. N Engl J Med 1979;300(10):513–517. DOI: 10.1056/NEJM197903083001001.
  23. Gislason T, Benediktsdottir B, Bjornsson JK, et al. Snoring, hypertension, and the sleep apnea syndrome. An epidemiologic survey of middle-aged women. Chest 1993;103(4):1147–1151. DOI: 10.1378/chest.103.4.1147.
  24. Guilleminault C, Stoohs R, Kim YD, et al. Upper airway sleep-disordered breathing in women. Ann Intern Med 1995;122(7):493–501. DOI: 10.7326/0003-4819-122-7-199504010-00003.
  25. Young T, Hutton R, Finn L, et al. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 1996;156(21):2445–2451. DOI: 10.1001.
  26. Redline S, Kump K, Tishler PV, et al. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 1994;149(3 Pt 1):722–726. DOI: 10.1164/ajrccm.149.3.8118642.
  27. Popovic RM, White DP. Influence of gender on waking genioglossal electromyogram and upper airway resistance. Am J Respir Crit Care Med 1995;152(2):725–731. DOI: 10.1164/ajrccm.152.2.7633734.
  28. Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol 1998;84(3):1055–1062. DOI: 10.1152/jappl.1998.84.3.1055.
  29. Brooks LJ, Strohl KP. Size and mechanical properties of the pharynx in healthy men and women. Am Rev Respir Dis 1992;146(6):1394–1397. DOI: 10.1164/ajrccm/146.6.1394.
  30. Brown IG, Zamel N, Hoffstein V. Pharyngeal cross-sectional area in normal men and women. J Appl Physiol 1986;61(3):890–895. DOI: 10.1152/jappl.1986.61.3.890.
  31. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017;13(3):479–504. DOI: 10.5664/jcsm.6506.
  32. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest 2014;146(5):1387–1394. DOI: 10.1378/chest.14-0970.
  33. Park JG, Ramar K, Olson EJ. Updates on definition, consequences, and management of obstructive sleep apnea. Mayo Clin Proc 2011;86(6):549–554. DOI: 10.4065/mcp.2010.0810.
  35. Crocker B, Olson LG, Saunders NA, et al. Estimation of the probability of disturbed breathing during sleep before a sleep study. Am J Respir Crit Care Med 1990;142(1):14–18. DOI: 10.1164/ajrccm/142.1.14.
  36. Randerath WJ. Sleep apnoea – current diagnosis and treatment. In: Ruhle KH. History and questionnaire. Karger Medical and Scientific Publisher. 2006. p. 38.
  37. Ohayon MM, Guillemiault C, Priest RG, et al. Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ 1997;314(7084):860–863. DOI: 10.1136/bmj.314.7084.860.
  38. Whyte KF, Allen MB, Jeffrey AA, et al. Clinical features of the sleep apnea/hypopnea syndrome. Q J Med 1989;72(267):659–666. DOI: 10.1056.
  39. Randerath WJ. Sleep apnoea – current diagnosis and treatment. In: Yim S. OSA – clinical presentation, diagnosis and treatment. Karger Medical and Scientific Publisher. 2006. p. 121.
  40. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ 2000;320(7233): 479–482. DOI: 10.1136/bmj.320.7233.479.
  41. Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342(19):1378–1384. DOI: 10.1056/NEJM200005113421901.
  42. Randerath WJ. Sleep apnoea – current diagnosis and treatment. In Yim S. OSA – clinical presentation, diagnosis and treatment. Karger Medical and Scientific Publisher. 2006. p. 131.
  43. Bixler E, Vgontazas A, Ten Have T, et al. Effects of age on sleep apnea in men. Am J Respir Crit Care Med 1998;157(1):144–148. DOI: 10.1164/ajrccm.157.1.9706079.
  44. Bixler E, Vgontzas A, Lin H, et al. Prevalence of sleep-disordered breathing in women. Am J Respir Crit Care Med 2001;163(3 Pt 1):608–613. DOI: 10.1164/ajrccm.163.3.9911064.
  45. Durán J, Esnaola S, Rubio R, et al. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30–70 yr. Am J Respir Crit Care Med 2001;163(3 Pt 1):685–689. DOI: 10.1164/ajrccm.163.3.2005065.
  46. Redline S. Epidemiology of sleep-disordered breathing. Semin Respir Crit Care Med 1998;19(2):113–122. DOI: 10.1055/s-2007-1009388.
  47. Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community dwelling adults: the Seep Heart Health Study. Arch Intern Med 2002;162(8):893–900. DOI: 10.1001/archinte.162.8.893.
  48. Ancoli-Israel S, Kripke D, Klauber M, et al. Sleep-disordered breathing in community-dwelling elderly. Sleep 1991;14(6):486–495. DOI: 10.1093/sleep/14.6.486.
  49. Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnea and snoring in 1001 middle aged men. Thorax 1991;46(2):85–90. DOI: 10.1136/thx.46.2.85.
  50. Mortimore IL, Marshall I, Wraith PK, et al. Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med 1998;157(1):280–283. DOI: 10.1164/ajrccm.157.1.9703018.
  51. Young T, Finn L, Austin D, et al. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort study. Am J Respir Crit Care Med 2002;167(9):1181–1185. DOI: 10.1164/rccm.200209-1055OC.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.