BACKGROUND: Diagnosing obstructive sleep apnea (OSA) is clinically relevant 
because untreated OSA has been associated with increased morbidity and 
mortality. The STOP-Bang questionnaire is a validated screening tool for OSA. We 
conducted a systematic review and meta-analysis to determine the effectiveness 
of STOP-Bang for screening patients suspected of having OSA and to predict its 
accuracy in determining the severity of OSA in the different populations.
METHODS: A search of the literature databases was performed. Inclusion criteria 
were: 1) Studies that used STOP-Bang questionnaire as a screening tool for OSA 
in adult subjects (>18 years); 2) The accuracy of the STOP-Bang questionnaire 
was validated by polysomnography--the gold standard for diagnosing OSA; 3) OSA 
was clearly defined as apnea/hypopnea index (AHI) or respiratory disturbance 
index (RDI) ≥ 5; 4) Publications in the English language. The quality of the 
studies were explicitly described and coded according to the Cochrane Methods 
group on the screening and diagnostic tests.
RESULTS: Seventeen studies including 9,206 patients met criteria for the 
systematic review. In the sleep clinic population, the sensitivity was 90%, 94% 
and 96% to detect any OSA (AHI ≥ 5), moderate-to-severe OSA (AHI ≥15), and 
severe OSA (AHI ≥30) respectively. The corresponding NPV was 46%, 75% and 90%. A 
similar trend was found in the surgical population. In the sleep clinic 
population, the probability of severe OSA with a STOP-Bang score of 3 was 25%. 
With a stepwise increase of the STOP-Bang score to 4, 5, 6 and 7/8, the 
probability rose proportionally to 35%, 45%, 55% and 75%, respectively. In the 
surgical population, the probability of severe OSA with a STOP-Bang score of 3 
was 15%. With a stepwise increase of the STOP-Bang score to 4, 5, 6 and 7/8, the 
probability increased to 25%, 35%, 45% and 65%, respectively.
CONCLUSION: This meta-analysis confirms the high performance of the STOP-Bang 
questionnaire in the sleep clinic and surgical population for screening of OSA. 
The higher the STOP-Bang score, the greater is the probability of 
moderate-to-severe OSA.