Stop-bang questionnaire as a screening tool for obstructive sleep apnoea in the surgical population: a prospective observational study


  • Kajal Shetty
  • Rashmi Soori



OSA, difficult airway, modified STOP Bang questionnaire


Introduction and Aim: Obstructive sleep apnoea (OSA) is a type of sleep-related breathing disorder characterized by repetitive episodes of partial and complete pharyngeal collapse causing a reduction or total cessation of airflow during sleep. Undiagnosed, it increases the intraoperative and postoperative complications. This study aimed to screen patients undergoing surgical procedures for OSA using a validated self-report STOP-Bang questionnaire.


Materials and Methods: This prospective observational study was conducted in a tertiary care hospital between June and November 2021 and included 174 patients posted for elective surgery. A modified STOP-Bang questionnaire was used to evaluate participants for OSA. Documentation also included the difficulty in mask holding, number of attempts at laryngoscopy and intubation, the type and size of the endotracheal tube, and attempts to place a supraglottic airway device.


Results: The prevalence of self-reported OSA was 5.2% (n=9) among the 174 participants included in this study. Among the patients (n=98) who underwent general anaesthesia 32 had difficult airways, among which 20 (62.5%) had a predictor of difficult airway and two had OSA. One among the 2 OSA patients had other predictors of difficult airway. No statistical significance was observed between OSA and the difficult airway (p=0.723). However, a clinically significant association was seen for difficult mask holding for patients with OSA but having no other predictors of difficult airway.


Conclusion: Using the STOP-Bang questionnaire to screen OSA in patients undergoing general anaesthesia or sedation can help the anaesthesiologist manage difficult airways more effectively.

Author Biographies

Kajal Shetty

Department of Anaesthesia and Operation Technology, Acharya Institute of Allied Health Sciences, Bengaluru, India

Rashmi Soori

Department of Anaesthesiology, K.S. Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India


Park, D.Y., Kim, J.S., Park, B., Kim, H.J. Risk factors and clinical prediction formula for the evaluation of obstructive sleep apnoea in Asian adults. PLoS One. 2021; 16(2): e0246399.

Leong, W.B., Arora, T., Jenkinson, D., Thomas, A., Punamiya, V., Banerjee, D., et al., The prevalence and severity of obstructive sleep apnoea in severe obesity: the impact of ethnicity. Journal of Clinical Sleep Medicine. 2013;9(9):853-858.

Tan, A., Yin, J.D., Tan, L.W., van Dam, R.M., Cheung, Y.Y., Lee C.H. Predicting obstructive sleep apnoea using the STOP-Bang questionnaire in the general population. Sleep medicine. 2016; 27:66-71.

Lockhart, E.M., Willingham, M.D., Abdallah, A.B., Helsten, D. L., Bedair, B.A., Thomas, J., et al., Obstructive sleep apnea screening and postoperative mortality in a large surgical cohort. Sleep Medicine, 14(5): 407-415.

Seet, E., Chua, M., Liaw, C.M. High STOP-BANG questionnaire scores predict intraoperative and early postoperative adverse events. Singapore medical journal. 2015;56(4):212.

Kaw, R., Chung, F., Pasupuleti, V., Mehta, J., Gay, P. C., Hernández, A. V. Meta analysis of the association between obstructive sleep apnoea and postoperative outcome. British Journal of Anaesthesia. 2012;109(6):897-906.

Franklin, K.A., Lindberg, E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. Journal of thoracic disease. 2015;7(8):1311-1322.

Singh, M., Liao, P., Kobah, S., Wijeysundera, D.N., Shapiro, C., Chung, F. Proportion of surgical patients with undiagnosed obstructive sleep apnoea. British journal of anaesthesia. 2013;110(4):629-636.

Corso, R.M., Petrini, F., Buccioli, M., Nanni, O., Carretta, E., Trolio, A., et al., Clinical utility of preoperative screening with STOP-Bang questionnaire in elective surgery. Minerva Anestesiol. 2014;80(8):877-884.

Hwang, M., Zhang, K., Nagappa, M., Saripella, A., Englesakis, M., Chung, F. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnoea in patients with cardiovascular risk factors: a systematic review and meta-analysis. BMJ open respiratory research. 2021;8(1): e000848.

Pivetta, B., Chen, L., Nagappa, M., Saripella, A., Waseem, R., Englesakis, M., et al., Use and performance of the STOP-Bang questionnaire for obstructive sleep apnoea screening across geographic regions: a systematic review and meta-analysis. JAMA network open. 2021;4(3): e211009.

Chen, L., Pivetta, B., Nagappa, M., Saripella, A., Islam, S., Englesakis, M., et al., Validation of the STOP-Bang questionnaire for screening of obstructive sleep apnoea in the general population and commercial drivers: a systematic review and meta-analysis. Sleep and Breathing. 2021; 25(4):1741-1751.

Nunes, F. S., Danzi-Soares, N.J., Genta, P.R., Drager, L.F., Cesar, L.A., Lorenzi-Filho, G. Critical evaluation of screening questionnaires for obstructive sleep apnoea in patients undergoing coronary artery bypass grafting and abdominal surgery. Sleep and Breathing. 2015 ;19(1):115-122.

Boynton, G., Vahabzadeh, A., Hammoud, S., Ruzicka, D. L., Chervin, R.D. Validation of the STOP-BANG questionnaire among patients referred for suspected obstructive sleep apnoea. Journal of sleep disorders--treatment & care. 2013;2(4).

Kitakata, H., Kohno, T., Fukuda, K. Sleep-disordered breathing in the elderly: is it distinct from that in the younger or middle-aged populations?. Journal of thoracic disease. 2018; 10 (9):S1102.

Soori, R., D’Sa, I., Hosmane, G. The Utility of Epworth Sleepiness Scale to Screen Moderate and Severe Obstructive Sleep Apnoea Preoperatively to Predict Difficult Airway. Journal of Health and Allied Sciences NU. 2021;11(02):093-096.

Jehan, S., Zizi, F., Pandi-Perumal, S.R., Wall, S., Auguste, E., Myers, A.K., et al., Obstructive sleep apnoea and obesity: implications for public health. Sleep medicine and disorders: international journal. 2017;1(4).

Manabe, Y., Iwamoto, S., Miyawaki, H., Seo, K., Sugiyama, K. Mallampati classification without tongue protrusion can predict difficult tracheal intubation more accurately than the traditional Mallampati classification. Oral Science International. 2014;11(2):52-55.

Huitink, J.M., Bouwman, R.A. The myth of the difficult airway: airway management revisited. Anaesthesia. 2015;70(3):244-249.

Agrawal, S., Gupta, R., Lahan, V., Mustafa, G., Kaur, U. Prevalence of obstructive sleep apnoea in surgical patients presenting to a tertiary care teaching hospital in India: A preliminary study. Saudi journal of anaesthesia. 2013;7(2):155-159.

Appleton, S., Gill, T., Taylor, A., McEvoy, D., Shi, Z., Hill, C., et al., Influence of gender on associations of obstructive sleep apnoea symptoms with chronic conditions and quality of life. International journal of environmental research and public health. 2018;15(5):930-941.

Leong, S.M., Tiwari, A., Chung, F., Wong, D.T. Obstructive sleep apnoea as a risk factor associated with difficult airway management-A narrative review. Journal of Clinical Anaesthesia. 2018;45:63-68.




How to Cite

Shetty K, Soori R. Stop-bang questionnaire as a screening tool for obstructive sleep apnoea in the surgical population: a prospective observational study. Biomedicine [Internet]. 2023 Feb. 26 [cited 2024 Mar. 3];43(1):236-42. Available from:

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