Volume: 46 Issue: 2
Year: 2026, Page: 119-125, Doi: https://doi.org/10.51248/v46i2.210
Received: Oct. 30, 2026 Accepted: April 8, 2026 Published: April 23, 2026
Background: Obstructive sleep apnea (OSA) is associated with a range of cardiovascular, metabolic, and neurocognitive complications. While polysomnography (PSG) remains the gold standard for diagnosing OSA, its limited accessibility necessitates the use of reliable screening tools, particularly in resource-limited settings.
Objective: This study aimed to evaluate and compare the diagnostic performance of commonly used questionnaires, Epworth Sleepiness Scale (ESS), STOP, STOP-BANG, and Berlin Questionnaire in detecting moderate to severe OSA (Apnea-Hypopnea Index >15).
Methods: In this prospective observational study, 54 adult patients with suspected OSA underwent overnight Level 2 PSG. Participants were given ESS, STOP, STOP-BANG, and Berlin questionnaires prior to the sleep study. Diagnostic metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) were calculated. Agreement with PSG was assessed using Kappa statistics and McNemar’s test.
Results: The prevalence of moderate to severe OSA was 68.5% ( n= 37) . STOP-BANG and Berlin questionnaires demonstrated the highest sensitivity (97.3%), while ESS showed the highest specificity (64.7%) and PPV (75%). However, all tools exhibited low specificity (<12%) except ESS. Kappa values indicated poor agreement with PSG across all tools (κ < 0.12), and McNemar’s test showed significant discordance due to high false-positive rates in STOP, STOP-BANG, and Berlin tools.
Conclusion: ESS offers better specificity but lower sensitivity. In resource-limited environments, these tools may be useful for initial triage, but confirmatory PSG remains essential for accurate diagnosis and management. A combined or stepwise approach may optimize diagnostic accuracy.
Keywords: Obstructive sleep apnea, Epworth Sleepiness Scale, Berlin Questionnaire, STOP BANG
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Meghana M, Srishankar Bairy, Eldhos Jacob, Carishma S, Ajither PA. Evaluating Screening Tools for Moderate to Severe Obstructive Sleep Apnea: Early Detection to Avoid Complication. Biomedicine: 2026, 46(2): 119-125