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Some considerations for appropriate patient selection and results interpretation:

• The STOP-Bang has low specificity (30%) and positive predictive values (10%) in the general population.
• A score of 3 or higher is highly sensitive (90%) for OSA in obese pre-operative patients (68% prevalence) and sleep study patients (85% prevalence) but is not specific (50%).
• Scores in pre-operative patients correlate with increased unexpected intra-operative and early post-operative adverse events. Study rates above may not reflect your population.
• Neither STOP-Bang nor nocturnal oximetry are diagnostic for OSA. Avoid changing management with discordant results.
• If the STOP-Bang is high in an obese patient a negative nocturnal oximetry will not reliably reassure.
• Similarly a low risk patient should not get nocturnal oximetry as false positives are likely.

1. Reference: Chung F, Yang Y, Liao P. Predictive Performance of the STOP-Bang Score for Identifying Obstructive Sleep Apnea in Obese Patients OBES SURG (2013) 23:2050-2057 DOI 10.1007/s11695-013-1006-z
2. Reference: Nagappa M, Liao P, Wong J, et al. Validation of the STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea among Different Populations: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(12):e0143697. Published 2015 Dec 14. doi:10.1371/journal.pone.0143697
3. Reference: Seet E, Chua M, Liaw CM. High STOP-BANG questionnaire scores predict intraoperative and early postoperative adverse events. Singapore Med J. 2015;56(4):212-6.