Screening

The American Academy of Sleep Medicine recommends that workers who perform safety sensitive functions in the transportation industry should be screened for OSA using both self-reported symptoms and established, objectively measurable criteria such as blood pressure and body weight.[27] Suspected OSA can be confirmed with polysomnography. Polysomnography is not, however, an appropriate systematic screening test because of its high expense and relative complexity.[91]

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in the general adult population.[92]

STOP questionnaire

The STOP (Snoring, Tiredness, Observed apnea, high blood Pressure) questionnaire includes four items, with a potential total score of four:[93]

  1. Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?

  2. Do you often feel tired, fatigued, or sleepy during the daytime?

  3. Has anyone observed you stop breathing during your sleep?

  4. Do you have or are you being treated for high blood pressure?

A STOP score ≥ 2 indicates high risk for OSA.[94] The STOP questionnaire may have a role in clinical settings in resource-poor countries, or when polysomnography is not available. Sensitivity may be improved when combined with body mass index, age, neck size, and gender (STOP-BANG).[93]

STOP-BANG questionnaire

The STOP-BANG questionnaire comprises the STOP questions, plus four objective measures (risk factors for OSA):

  • Body Mass Index (>35 kg/m² +1)

  • Age (>50 years +1)

  • Neck size (>40 cm+1)

  • Gender (male +1)

For the general population, OSA risk is:

  • Low (yes to 0-2 questions)

  • Intermediate (yes to 3-4 questions)

  • High (yes to 5-8 questions)

The STOP-BANG questionnaire has been reported to have high sensitivity to detect OSA; however, it requires further study in the general population.[95][96][97][98]​ STOP-BANG may be a more accurate tool for detecting OSA than the Epworth sleepiness scale, Berlin, and STOP questionnaires.

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