Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder; however, it 
remains underdiagnosed and undertreated. Although screening tools such as the 
Berlin questionnaire (BQ), STOP-BANG questionnaire (SBQ), STOP questionnaire 
(STOP), and Epworth sleepiness scale (ESS) are widely used for OSA, the findings 
regarding their diagnostic accuracy are controversial. Therefore, this 
meta-analysis investigated and compared the summary sensitivity, specificity, 
and diagnostic odds ratio (DOR) among the BQ, SBQ, STOP, and ESS according to 
the severity of OSA. Electronic databases, namely the Embase, PubMed, PsycINFO, 
ProQuest dissertations and theses A&I databases, and China knowledge resource 
integrated database, were searched from their inception to July 15, 2016. We 
included studies examining the sensitivity and specificity of the BQ, SBQ, STOP, 
and ESS against the apnea-hypopnea index (AHI) or respiratory disturbance index 
(RDI). The revised quality assessment of diagnostic accuracy studies was used to 
evaluate the methodological quality of studies. A random-effects bivariate model 
was used to estimate the summary sensitivity, specificity, and DOR of the tools. 
We identified 108 studies including a total of 47 989 participants. The summary 
estimates were calculated for the BQ, SBQ, STOP, and ESS in detecting mild 
(AHI/RDI ≥ 5 events/h), moderate (AHI/RDI ≥ 15 events/h), and severe OSA 
(AHI/RDI ≥ 30 events/h). The performance levels of the BQ, SBQ, STOP, and ESS in 
detecting OSA of various severity levels are outlined as follows: for mild OSA, 
the pooled sensitivity levels were 76%, 88%, 87%, and 54%; pooled specificity 
levels were 59%, 42%, 42%, and 65%; and pooled DORs were 4.30, 5.13, 4.85, and 
2.18, respectively. For moderate OSA, the pooled sensitivity levels were 77%, 
90%, 89%, and 47%; pooled specificity levels were 44%, 36%, 32%, and 621%; and 
pooled DORs were 2.68, 5.05, 3.71, and 1.45, respectively. For severe OSA, the 
pooled sensitivity levels were 84%, 93%, 90%, and 58%; pooled specificity levels 
were 38%, 35%, 28%, and 60%; and pooled DORs were 3.10, 6.51, 3.37, and 2.10, 
respectively. Therefore, for mild, moderate, and severe OSA, the pooled 
sensitivity and DOR of the SBQ were significantly higher than those of other 
screening tools (P < .05); however, the specificity of the SBQ was lower than 
that of the ESS (P < .05). Moreover, age, sex, body mass index, study sample 
size, study populations, presence of comorbidities, PSG or portable monitoring 
performance, and risk of bias in the domains of the index test and reference 
standard were significant moderators of sensitivity and specificity (P < .05). 
Compared with the BQ, STOP, and ESS, the SBQ is a more accurate tool for 
detecting mild, moderate, and severe OSA. Sleep specialists should use the SBQ 
to conduct patient interviews for the early diagnosis of OSA in clinical 
settings, particularly in resource-poor countries and sleep clinics where PSG is 
unavailable.