The STOP-Bang Questionnaire can be an effective tool in screening patients with multiple sclerosis for moderate to severe obstructive sleep apnea (OSA), although the questionnaire may not adequately rule out mild OSA, according to study results published in the Multiple Sclerosis Journal.
Although OSA is sequential and widespread in patients with multiple sclerosis, it is often underdiagnosed in this population. To improve screening for OSA in patients with multiple sclerosis, a team of researchers used the STOP-Bang questionnaire, an 8-point tool often used as a screening tool (validated against overnight polysomnography) for OSA in patients without multiple Sclerosis is used. The aim of the present study was to find out whether STOP-Bang is also valid when screening for OSA in patients with multiple sclerosis.
A total of 200 patients (mean age 48.8 years; women 69%; whites 85%) with multiple sclerosis were included in the analysis. Study researchers collected data from 124 people from an ongoing, randomized controlled trial at a single center (ClinicalTrials.gov Identifier: NCT02544373) and collected data from 76 people who were clinical patients.
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The results showed a polysomnographically confirmed OSA diagnosis in 78% of the patients (mild 39%; moderate 21.5%; severe 17.5%). The median time between STOP-Bang screening and overnight polysomnography was 0 days in study patients and 55.5 days in clinical patients.
The observed STOP-Bang values (between 0 and 8) were between 0 and 7 for the study participants, with around 70% of the people giving a value of 3 or higher and 26% of the participants giving a value of 5 or higher. With a STOP-Bang threshold of 3 or higher, apnea-hypopnea index scores of 5 or higher, 15 or higher, and 30 or higher were associated with specificities of 57%, 43% and 36%, respectively. The same threshold had a sensitivity of 87% for detecting moderate OSA and a sensitivity of 91% for detecting severe OSA; however, the sensitivity for the detection of a milder OSA was 76%. The negative predictive value for identifying people without milder forms of OSA was 40%.
The study authors noted that, “The sensitivity of this tool for detecting patients with lighter forms of OSA was less robust, and the [negative-predictive value] the STOP bang to correctly classify people without mild OSA was bad. “
“Our results support the use of the STOP-Bang as an effective tool for screening for moderate and severe OSA [people with multiple sclerosis] and suggest that providers should consider incorporating this tool into clinical practice. Since the STOP-Bang’s limited ability to rule out mild OSA may partly reflect the high prevalence of OSA in this sample, decisions about the need for OSA assessments in patients with low STOP-Bang scores should be determined by clinical judgment ” concluded the study researchers.
reference
M. Singh, R. Gavidia, GL. Dunietz et al. Validation of an inventory of symptoms of obstructive sleep apnea in people with multiple sclerosis. Mult Scler. Published online May 28, 2021. doi: 10.1177 / 13524585211013014
