Quick Answer: STOP-Bang is an 8-question screening tool for obstructive sleep apnea. A score of 0 to 2 is low risk and 5 to 8 is high risk. A 3 or 4 needs extra criteria, such as a BMI over 35 (Chung 2016). A high score is a reason to ask about a sleep study, not a diagnosis.
Want a quick check of your own warning signs? Our sleep apnea risk calculator goes through night signs, daytime symptoms and risk factors, and tells you whether to ask your doctor about a sleep test.
What Is The STOP-Bang Questionnaire?
STOP-Bang is a short list of eight yes-or-no questions about the clinical features of sleep apnea. The 2016 review describes it as a reliable, concise and easy-to-use screening tool. Doctors use it to decide who needs a closer look, not to give a diagnosis.
The name is a memory aid. The first four letters are symptoms and history. The last four are body measures and background. In the Chung 2012 study, the questions were as follows (Chung et al. 2012):
Put in plain words, the eight items are loud snoring, daytime tiredness, observed pauses in breathing and high blood pressure (or treatment for it). The rest are a BMI over 35, age over 50, a neck circumference over 40 centimeters (about 16 inches) and male sex. Your doctor can go through the exact wording with you, and our own risk calculator uses a different set of questions.
How Is STOP-Bang Scored?
Each yes scores 1 point, so the total runs from 0 to 8. For example, someone over 50 who is male, snores loudly and feels tired by day scores 4, which is the middle range.
The original form used a simple split: yes to 3 or more questions is high risk, and fewer than 3 is low risk. The 2016 review adds a middle band and splits the range more finely (Chung 2016).
| Score | Risk Band | What It Means |
|---|---|---|
| 0 to 2 | Low risk | Low risk of moderate to severe sleep apnea |
| 3 or 4 | Middle range | Further criteria are needed to classify you. One example is a BMI over 35 |
| 5 to 8 | High risk | High risk of moderate to severe sleep apnea |
Moderate to severe means an apnea-hypopnea index (AHI) over 15, which is more than 15 breathing pauses or slowdowns an hour. Severe means an AHI over 30.
How Accurate Is STOP-Bang?
It is good at catching serious cases. The 2016 review reports that a score of 3 or higher had a sensitivity of 93% for moderate to severe sleep apnea and 100% for severe (Chung 2016). Sensitivity is the share of people with the condition who score at or above the cut-off.
The same review reports negative predictive values of 90% and 100%. A negative predictive value is the share of people with a low result who truly do not have the condition.
It is less good at saying who does not have it. The 2012 study followed 746 adults scheduled for surgery who also had an overnight sleep study. The chance of moderate to severe sleep apnea rose from 18% at a score of 0 to 2 to 60% at a score of 7 or 8. The chance of severe sleep apnea rose from 4% to 38% (Chung et al. 2012).
The chart shows the same trend in plain terms. Higher scores mean a higher chance, but even the top score was not a sure thing.
This group was older and had a lot of sleep apnea: median age 60, 49% male, and 38.5% had moderate to severe disease. In a healthier group, the same score would likely mean a different chance.
What Does A High STOP-Bang Score Mean?
In the 2012 study, a score of 5 to 8 identified patients with a high probability of moderate to severe sleep apnea. It does not diagnose it. A sleep study measures breathing overnight and is the way to confirm sleep apnea and grade it.
If you are having surgery, tell the anesthesia team your score. The 2012 authors say the score can help the healthcare team plan extra precautions around surgery and decide who to send for testing.
NHLBI says your provider may ask you to see a sleep specialist or go to a center for a sleep study. Sleep studies can help diagnose which type of sleep apnea you have and how serious it is (NHLBI).
The 2012 authors note that an overnight lab study is expensive and cumbersome, and that portable home monitoring might be an alternative when the chance is high. Read more in home sleep apnea test.
What Do Low And Middle Scores Mean?
A low score lowers the chance but does not remove it, so it should never talk you out of a symptom check. In the study, 18% of people who scored 0 to 2 still had moderate or worse sleep apnea (95% confidence interval 13% to 24%). The authors still treated that group as low risk.
A middle score of 3 or 4 is the gray zone, and it is where the extra criteria matter most. The 2016 review says further criteria are needed there, with a BMI over 35 as one example. If you have symptoms, tell your doctor even when your score is low. See obstructive sleep apnea symptoms for the signs to watch for.
What Are The Limits Of STOP-Bang?
Know these limits before you trust a score:
- The 2012 data came from surgery patients at preoperative clinics, and the authors say results may not apply to other groups. They call for more testing in the general population.
- Patients with sleep symptoms may have been more likely to join the study, which could bias the results.
- Some patients had lab sleep studies and others had portable home studies, so the two methods may differ slightly.
- Like other screening studies, it did not evaluate central sleep apnea separately.
The 2012 authors say a cut-off of 3 or higher may suit groups where sleep apnea is common, such as bariatric surgery patients. For everyone else, treat any single number as a rough guide, not a verdict.
How To Use Your Score With A Doctor
A score is most useful when it starts a conversation. Here is a simple way to prepare:
- Answer the questions honestly, and ask your partner about the observed-pauses item.
- Write down your BMI, age and neck size so the numbers are accurate.
- Note how sleepy you feel by day, using a sleep diary if you can. NHLBI says a diary tracks how long and how well you sleep and how sleepy you feel.
- Tell your provider your score, your symptoms and any family history of sleep apnea.
- Ask whether a sleep study is the right next step, and whether a home test could work.
For more on screening options, read sleep apnea screening tests.
NHLBI says your provider will ask about your symptoms, your risk factors and whether sleep apnea runs in your family. Your STOP-Bang answers are a useful way to organize that talk.
The three steps show where STOP-Bang fits. It estimates risk, your provider decides what to do with it, and the sleep study gives the answer. See how to read sleep study results once you have one.
When To See A Doctor
See a doctor if: someone has seen you stop breathing in your sleep, you snore loudly or gasp at night, or you feel very sleepy in the day, whatever your score. A low score does not mean you are safe, so act on symptoms.
If you nod off while driving, stop driving and get help soon.
For a specialist visit, see when to see a sleep specialist.
FAQs About The STOP-Bang Questionnaire
Is A STOP-Bang Score Of 3 High Risk?
Under the original form, yes. The 2016 review calls 3 or 4 the middle range, where further criteria such as a BMI over 35 decide the risk.
Can You Have Sleep Apnea With A Low STOP-Bang Score?
Yes. In the 2012 surgical study, 18% of people who scored 0 to 2 had moderate or worse sleep apnea. Tell your doctor about symptoms regardless of your score.
Is STOP-Bang A Diagnosis?
No. It is a screening tool that estimates risk. NHLBI says a sleep study is what helps diagnose which type you have and how serious it is.
Does The Questionnaire Work For Women?
The sources we used do not say. Male sex earns one point, so scores may differ between men and women. The 2012 study had 49% men, but it does not report results by sex here.
What Should I Do With A High Score?
Take it to your doctor. NHLBI says a provider may refer you to a sleep specialist, and a sleep study can confirm sleep apnea.
Your Next Step
Go through night signs, daytime symptoms and risk factors. It is a screening aid, not a diagnosis.