STOP-BANG Score
Screen for obstructive sleep apnea (OSA) risk using the STOP-BANG score. Stratify perioperative respiratory monitoring needs and guide postoperative disposition and opioid management.
Based on: AASM · ASA
Input
Clinical reasoning
A 62-year-old man scheduled for elective colectomy. Reports loud snoring, daytime sleepiness, treated hypertension. BMI 38, neck circumference 45 cm.
What is the most appropriate perioperative approach for this patient?
Overview
STOP-BANG Score for perioperative respiratory risk screening. Eight binary items identify patients at higher risk of obstructive sleep apnea — guiding decisions on monitoring intensity, opioid use, airway preparation, and postoperative disposition.
Evidence Summary
The STOP-BANG questionnaire was developed and validated by Chung et al. (2008) specifically for surgical patients. Eight yes/no items covering snoring, tiredness, observed apnea, hypertension, BMI, age, neck circumference, and gender produce a score from 0 to 8. It offers high sensitivity for moderate-to-severe OSA (80–90% at a threshold of ≥5) while remaining rapid and simple to administer.
OSA increases perioperative risk through several overlapping mechanisms. Anesthesia, sedation, and opioids impair upper airway muscle tone, predisposing to obstructive apnea and hypoxemia. The first postoperative night — when REM sleep rebounds after surgical suppression — is the period of highest risk. Opioids used for postoperative analgesia compound this by adding central respiratory depression to obstructive events. Unrecognized OSA patients face elevated rates of serious postoperative hypoxemia, unplanned ICU transfer, and reintubation.
| Score | Risk category | Estimated moderate–severe OSA prevalence | Perioperative approach |
|---|---|---|---|
| 0–2 | Low risk | ≈ 4–5% | Standard perioperative management |
| 3–4 | Intermediate risk | ≈ 11–27% | Enhanced monitoring + opioid minimization |
| ≥ 5 | High risk | ≈ 48–90% | Comprehensive precautions + extended monitoring |
This tool screens for perioperative respiratory risk — not OSA diagnosis
A high STOP-BANG score predicts perioperative respiratory events more usefully than it confirms a formal diagnosis of OSA. A low score reduces — but does not eliminate — OSA probability. Clinical context, surgical urgency, existing diagnoses, and institutional protocols determine the appropriate next step. Formal diagnosis requires polysomnography.