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STOP-BANG Sleep Apnea Screener

A validated screening tool used by doctors worldwide to assess obstructive sleep apnea risk.

0 of 8

S.Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?

T.Do you often feel tired, fatigued, or sleepy during the daytime?

O.Has anyone observed you stop breathing or choking/gasping during your sleep?

P.Are you being treated for high blood pressure?

B.Is your BMI greater than 35?

A.Are you over 50 years old?

N.Is your neck circumference greater than 16 inches (40 cm)?

A men's dress shirt collar size 16+ inches, or a medium t-shirt that feels tight at the neck.

G.Are you male?

This refers to biological sex assigned at birth, which affects airway anatomy and sleep apnea risk.

What This Tool Measures

The STOP-BANG questionnaire is a screening tool that estimates your risk of having obstructive sleep apnea (OSA) based on eight yes-or-no questions. Each question addresses a known risk factor for OSA: loud snoring, daytime tiredness, observed breathing pauses, high blood pressure, elevated BMI, age over 50, large neck circumference, and male sex. Your total score (0 to 8) places you in a low, intermediate, or high risk category.

Clinical Background

The STOP-BANG questionnaire was developed by Dr. Frances Chung and colleagues at the University of Toronto in 2008. It was originally designed to screen surgical patients for undiagnosed OSA before anesthesia, because untreated OSA increases the risk of airway complications during and after surgery. The questionnaire has since been validated in general population studies and is now one of the most widely used OSA screening tools in clinical practice.

The original validation study (Chung et al., Anesthesiology, 2008) found a sensitivity of 83.6% for detecting any OSA (AHI 5 or higher) and 92.9% for moderate-to-severe OSA (AHI 15 or higher). A 2014 meta-analysis by Nagappa et al. in the British Journal of Anaesthesia confirmed high sensitivity (90% for moderate-to-severe OSA) across multiple populations. Specificity is moderate (37% to 56%), meaning the tool produces a meaningful rate of false positives. This is intentional: a screening tool should err on the side of catching cases rather than missing them.

The STOP-BANG is not a diagnostic tool. A high score indicates elevated risk and warrants formal evaluation with a sleep study (polysomnography or home sleep apnea test). Only a sleep study can confirm or rule out obstructive sleep apnea.

Scoring and Risk Levels

Each "yes" answer scores one point. The total score ranges from 0 to 8 and maps to three risk levels:

  • 0 to 2: Low Risk. Few risk factors present. OSA is possible but less likely based on this screening.
  • 3 to 4: Intermediate Risk. Several risk factors present. Consider discussing a sleep study with your provider, especially if you have symptoms like loud snoring or witnessed breathing pauses.
  • 5 to 8: High Risk. Multiple risk factors strongly associated with OSA. Formal evaluation with a sleep study is recommended.

These thresholds match the original scoring published by Chung et al. (2008). Some clinical guidelines use a cutoff of 3 or higher to recommend further testing, especially in preoperative settings where the consequences of missing undiagnosed OSA are higher.

Limitations

The STOP-BANG was developed and primarily validated in surgical and sleep clinic populations, which tend to have higher OSA prevalence than the general population. It may overestimate risk in younger, healthier populations. It does not screen for central sleep apnea, which involves a different mechanism (the brain failing to signal breathing rather than a physical airway obstruction). The questionnaire also has reduced sensitivity in women, who often present with OSA symptoms that differ from the classic pattern of loud snoring and witnessed apneas. If you are a woman with unexplained fatigue, insomnia, or morning headaches, consider discussing OSA screening with your provider even if your STOP-BANG score is low.

Frequently Asked Questions

How accurate is the STOP-BANG questionnaire?

A 2014 meta-analysis by Nagappa et al. found the STOP-BANG has a sensitivity of approximately 90% for detecting moderate-to-severe obstructive sleep apnea (AHI 15 or higher). The original 2008 validation study by Chung et al. found 92.9% sensitivity for moderate-to-severe OSA. Sensitivity measures how well the tool catches true cases. The trade-off is lower specificity (around 37% to 56%), which means a meaningful percentage of people who score high risk do not actually have OSA. A high STOP-BANG score is a strong signal to pursue formal testing, not a diagnosis.

What does each letter in STOP-BANG stand for?

S = Snoring (loud snoring), T = Tired (daytime fatigue or sleepiness), O = Observed (someone has seen you stop breathing during sleep), P = Pressure (treated for high blood pressure), B = BMI (body mass index above 35), A = Age (over 50 years old), N = Neck (neck circumference greater than 16 inches or 40 cm), G = Gender (male sex). Each yes answer scores one point for a total possible score of 0 to 8.

Can women use the STOP-BANG questionnaire?

Yes. The questionnaire is validated for both men and women. The G (Gender) question gives one point for male sex because OSA is roughly two to three times more prevalent in men than women in the general population. Women can still score high risk based on the other seven factors. Some research suggests the STOP-BANG may slightly underestimate risk in women because OSA in women often presents with different symptoms (insomnia, morning headaches, mood disturbance) that the questionnaire does not capture.

What should I do if I score high risk?

A high-risk STOP-BANG score (5 to 8) means you have multiple risk factors associated with obstructive sleep apnea. The recommended next step is a sleep study, either an in-lab polysomnography or a home sleep apnea test (HSAT). Talk to your primary care provider or ask for a referral to a sleep specialist. Many home sleep tests can now be ordered through telehealth appointments and shipped directly to your home.

Is the STOP-BANG the same as the Epworth Sleepiness Scale?

No. The STOP-BANG questionnaire screens for obstructive sleep apnea risk by evaluating anatomical and demographic risk factors. The Epworth Sleepiness Scale measures daytime sleepiness, which can be caused by many conditions beyond sleep apnea (including insufficient sleep, narcolepsy, medications, or depression). A person can have severe OSA with a normal Epworth score if their body has adapted to chronic sleep fragmentation. The two tools measure different things and are often used together.

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