Screening for obstructive sleep apnoea using the STOPBANG questionnaire

Editor – We read with interest the report by Isaac et al.¹ in which they screened for obstructive sleep apnoea (OSA) in acute medical take patients, in particular their use of the STOPBANG questionnaire.² We also have experience using this instrument, in the context of a cognitive disorders clinic based in a neurology centre,³ because of the possible contribution of OSA to symptoms of cognitive impairment.⁴

Our cohort of consecutive patients referred over a 3-month period with unexplained memory symptoms (n=67) was somewhat younger than that of Isaac et al (≤50 years of age: 12/67 = 18% vs 31/93 = 33%) and with a male preponderance (61% vs 43%). Nevertheless, using the STOPBANG score ≥3/8, the criterion for ‘suspected high risk of OSA’, around half of our patients screened positive (33/67 = 49% vs 73% in Isaac et al).

Evidently, STOPBANG is a highly sensitive test and therefore likely to detect prevalent cases of OSA, but in addition it will also identify large numbers of false positives; examination of the item content of STOPBANG shows that any tired male over 50 years of age will screen positive, ie score ≥3/8. Hence, as a stand-alone screen on which to base decisions about onward referral to services dedicated to diagnosis and treatment of OSA, use of STOPBANG might well prove overwhelming.³ We therefore endorse the idea of using a second screener, such as the Epworth sleepiness score (ESS), prior to initiating onward referral to OSA services in order to try to reduce the false positive rate.