Talk Description
Introduction:
The STOP-Bang is a widely used screening tool for perioperative obstructive sleep apnoea (OSA) and consists of eight equally weighted variables, each with varying predictive values [1,2]. However, the universal application of the STOP-Bang in surgical patients has been impeded by the numerous variables involved in calculating a final score.[1]. The B-APNEIC score is a new tool that includes only 4 variables from STOP-Bang: BMI (1 point), Arterial Pressure (1 point), NEck circumference (2 points), and witnessed interruptions or cessation of breathing (1 point). A cut-off of >/3 has been shown to predict severe OSA (apnoea-hypopnoea index, AHI >30/hr) [1]. STOP-Bang and B-APNEIC scores demonstrated similar effectiveness in predicting severe OSA in the original study [1], but they have yet to be validated. This study aimed to validate the B-APNEIC screening tool.
The STOP-Bang is a widely used screening tool for perioperative obstructive sleep apnoea (OSA) and consists of eight equally weighted variables, each with varying predictive values [1,2]. However, the universal application of the STOP-Bang in surgical patients has been impeded by the numerous variables involved in calculating a final score.[1]. The B-APNEIC score is a new tool that includes only 4 variables from STOP-Bang: BMI (1 point), Arterial Pressure (1 point), NEck circumference (2 points), and witnessed interruptions or cessation of breathing (1 point). A cut-off of >/3 has been shown to predict severe OSA (apnoea-hypopnoea index, AHI >30/hr) [1]. STOP-Bang and B-APNEIC scores demonstrated similar effectiveness in predicting severe OSA in the original study [1], but they have yet to be validated. This study aimed to validate the B-APNEIC screening tool.
Methods:
This study, approved by the Central Adelaide Local Health Network Ethics Committee (approval number 16242, April 2022), was conducted as an observational study and, therefore, not registered in a trial registry. After obtaining informed consent, we enrolled 252 patients who underwent overnight diagnostic polysomnography for suspected OSA. STOP-Bang and B-APNEIC scores were calculated, and their diagnostic accuracy in predicting severe OSA was compared. To predict severe OSA, a cut-off score of >/5 and >/3, respectively, were used as thresholds for STOP-Bang and B-APNEIC scores.
This study, approved by the Central Adelaide Local Health Network Ethics Committee (approval number 16242, April 2022), was conducted as an observational study and, therefore, not registered in a trial registry. After obtaining informed consent, we enrolled 252 patients who underwent overnight diagnostic polysomnography for suspected OSA. STOP-Bang and B-APNEIC scores were calculated, and their diagnostic accuracy in predicting severe OSA was compared. To predict severe OSA, a cut-off score of >/5 and >/3, respectively, were used as thresholds for STOP-Bang and B-APNEIC scores.
Results:
The average age of the patients was 55 years, with 50% being men. The mean STOP-Bang and B-APNEIC scores were 4.6 and 2.7 respectively. Of the 252 patients tested, 100 (40%) were confirmed to have severe OSA. The mean AHI of the total population was 31.3. In predicting severe OSA, the B-APNEIC score demonstrated significantly higher sensitivity compared to the STOP-Bang (86% vs 74%, p<0.01), while the specificities were similar (58% vs 55%, p=0.39). The B-APNEIC score showed significantly higher diagnostic accuracy than the STOP-Bang in predicting severe OSA (69% vs 62%, p=0.01). It also showed significantly higher area under the curve (AUC) values from receiver operating curve analysis than the STOP-Bang in predicting severe OSA (0.75 vs 0.70, p=0.02).
The average age of the patients was 55 years, with 50% being men. The mean STOP-Bang and B-APNEIC scores were 4.6 and 2.7 respectively. Of the 252 patients tested, 100 (40%) were confirmed to have severe OSA. The mean AHI of the total population was 31.3. In predicting severe OSA, the B-APNEIC score demonstrated significantly higher sensitivity compared to the STOP-Bang (86% vs 74%, p<0.01), while the specificities were similar (58% vs 55%, p=0.39). The B-APNEIC score showed significantly higher diagnostic accuracy than the STOP-Bang in predicting severe OSA (69% vs 62%, p=0.01). It also showed significantly higher area under the curve (AUC) values from receiver operating curve analysis than the STOP-Bang in predicting severe OSA (0.75 vs 0.70, p=0.02).
Discussion:
In the original study, both scores were equally effective in predicting severe OSA, with similar sensitivities and specificities [1]. The sensitivity for the STOP-Bang and B-APNEIC scores in predicting severe OSA in the original study was 66% and 69%, respectively. These values were lower than those found in our study (74% and 86%, respectively), indicating that the B-APNEIC score in our study had a superior ability to predict true positive cases. The original study revealed a specificity of 69% and 72% for STOP-Bang and B-APNEIC scores, respectively, in predicting severe OSA. In comparison, our study showed that both scores were poor in predicting the true negative cases, with a specificity of 55% and 58% for STOP-Bang and B-APNEIC scores, respectively. The original study found no difference in diagnostic accuracy and AUC between the two scores. In contrast, our study demonstrated that the B-APNEIC score outperformed the STOP-Bang score in terms of measures of diagnostic accuracy.
In the original study, both scores were equally effective in predicting severe OSA, with similar sensitivities and specificities [1]. The sensitivity for the STOP-Bang and B-APNEIC scores in predicting severe OSA in the original study was 66% and 69%, respectively. These values were lower than those found in our study (74% and 86%, respectively), indicating that the B-APNEIC score in our study had a superior ability to predict true positive cases. The original study revealed a specificity of 69% and 72% for STOP-Bang and B-APNEIC scores, respectively, in predicting severe OSA. In comparison, our study showed that both scores were poor in predicting the true negative cases, with a specificity of 55% and 58% for STOP-Bang and B-APNEIC scores, respectively. The original study found no difference in diagnostic accuracy and AUC between the two scores. In contrast, our study demonstrated that the B-APNEIC score outperformed the STOP-Bang score in terms of measures of diagnostic accuracy.
Conclusion:
The B-APNEIC score is a new, simplified, and quicker tool for predicting severe OSA. It has shown improved sensitivity and diagnostic accuracy compared to the STOP-Bang score but did not enhance specificity.
The B-APNEIC score is a new, simplified, and quicker tool for predicting severe OSA. It has shown improved sensitivity and diagnostic accuracy compared to the STOP-Bang score but did not enhance specificity.
References:
1.Morinigo R, Quraishi SA, Ewing S, Azocar RJ, Schumann R. The B-APNEIC score: distilling the STOP-Bang questionnaire to identify patients at high risk for severe obstructive sleep apnoea. Anaesthesia. 2022 Mar;77(3):286-292.
2.Nagappa M, Liao PU, Wong J, et al. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS One 2015; 10: e0143697.