To the Editor:
I read with great interest the article by Dobrosielski et al1 on their risk assessment for sleep-disordered breathing (SDB) in 51 collegiate football players by using the STOP-BANG questionnaire and finger pulse oximetry device. The STOP-BANG questionnaire consists of the following 8 dichotomous (yes/no) items: snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and male sex. Summing the score, ranging from 0 to 8, was used to specify high-risk and low-risk groups for SDB. The authors defined SDB as an apnea-hypopnea index (AHI) of ≥5, and about half of the players were categorized in the high-risk group for SDB by the STOP-BANG questionnaire. There was no significant difference in the prevalence of SDB between the 2 groups, and I surmise that there is no advantage of using the STOP-BANG questionnaire to specify SDB patients in athletes. I have some concerns regarding their study.
First, I think that football players have a tendency toward a large neck circumference and high body mass index, which would not be related to obesity. The STOP-BANG questionnaire was prepared for the general population, and there is difficulty applying the STOP-BANG questionnaire to athletes with muscularity. Taken together, the screening ability of the STOP-BANG questionnaire for football players should be approached with caution.
Second, I question the definition of SDB as AHI of ≥5. Chung et al2,3 overviewed the STOP-BANG questionnaire to screen for obstructive sleep apnea. The authors found that the sensitivity of a STOP-BANG score of ≥3 to detect moderate to severe obstructive sleep apnea (AHI >15) and severe obstructive sleep apnea (AHI >30) was 93 and 100%, respectively. In addition, corresponding negative predictive values were 90 and 100%. The same authors also presented predictive performance using sensitivity, specificity, positive predictive value, and negative predictive value by citing another reference by the authors.2,4 These reports showed that specificity and positive predictive value were not satisfactory when a STOP-BANG score of ≥3 was adopted as a cut-off point, but there is no information in these references that AHI of ≥5 was selected for diagnosing or ruling out SDB. Because the prevalence of SDB among collegiate football players was about 8% by using the mild SDB criteria of an AHI of ≥5, it seems that the SDB risk is relatively small as compared with the general population.
In summary, predictive performance differs by setting different cut-off points of STOP-BANG score and selecting different values of AHI as an accepted standard. There is a recent report on combination of the STOP-BANG questionnaire and a simple physiological apparatus for detecting obstructive sleep apnea,5 and it should be considered for further study.
Footnotes
The author has disclosed no conflicts of interest.
- Copyright © 2016 by Daedalus Enterprises
References
- 1.
- 2.
- 3.
- 4.
- 5.