BACKGROUND: An accurate, clinical screening tool for obstructive sleep apnea 
(OSA) that identifies patients for further diagnostic testing would assist in 
the diagnosis of this comorbidity. One example, the STOP-BANG questionnaire 
(SBQ), has been validated as a screening tool with high sensitivity. However, 
its specificity may result in a high false-positive rate. The aim of this study 
to determine if addition of the Modified Mallampati score to the SBQ improves 
its specificity.
METHODS: The authors studied 162 patients referred to the Sleep Disorders Clinic 
at Yedikule Chest Disease Education and Research Hospital. All patients were 
prospectively screened for risk of OSA using the SBQ, their oral anatomy was 
assessed by Modified Mallampati scoring, and sleep quality characterized by 
polysomnography. Polysomnography results were reviewed when available and the 
predictive performance of the SBQ and the modified SBQ scoring models were 
compared.
RESULTS: In the authors' study an SBQ score ≥3 yielded sensitivities of 0.85, 
0.86, and 0.91 for Apnea-Hypopnea Index (AHI) ≥5/h, AHI ≥15/h, and AHI ≥30/h, 
respectively, and specificities of 0.09, 0.10, and 0.18. The modified SBQ with a 
cutoff of ≥4 (>3) points for AHI levels of >5, >15, and >30 yielded respective 
sensitivities of 0.84, 0.86, and 0.91 and specificities of 0.25, 0.26, and 0.27.
CONCLUSIONS: The author's results from indicated the modified SBQ with a cutoff 
of >3 points in this study was more specific than the standard SBQ but no less 
sensitive, and may be used in identifying OSA patients for further diagnostic 
evaluation or avoiding unnecessary testing.