What question did this study set out to answer?

The aim is to compare the diagnostic performance of the ESS and STOP-BANG questionnaire in identifying OSA using polysomnography as the reference standard.

March 21, 2026Open Access

Comparative Analysis of ESS and STOP-BANG Questionnaires in Predicting Obstructive Sleep Apnea in Patients Undergoing Polysomnography: A Study from North Kashmir

Key Points

The aim is to compare the diagnostic performance of the ESS and STOP-BANG questionnaire in identifying OSA using polysomnography as the reference standard.
Conducted a cross-sectional analysis among 83 patients with OSA symptoms.
Applied the ESS and STOP-BANG questionnaires, followed by polysomnography.
Performed statistical analysis to compare sensitivity and specificity against PSG results.
Seventy-five patients were diagnosed with OSA based on AHI > 5.
ESS showed a sensitivity of 37.3% and specificity of 87.5%.
STOP-BANG identified OSA in 55 of 57 subjects, with sensitivity of 73.3% and specificity of 75%.
ROC analysis indicated higher accuracy for ESS (AUC = 0.833) compared to STOP-BANG (AUC = 0.703).

Abstract

Objective: To evaluate the predictive ability of the Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaire (SBQ) in diagnosing obstructive sleep apnea (OSA) and compare their diagnostic performance against polysomnography (PSG).Materials and methods: This is a cross-sectional study conducted in the Department of Chest Medicine, Government Medical College, Baramulla, Jammu and Kashmir, India, among 83 patients with symptoms of snoring, choking during sleep, excessive daytime sleepiness, breathlessness, and witnessed apnea.The SBQ and ESS were used on the patients, and scoring was done, followed by an overnight attended PSG.Statistical analysis was done after obtaining all the values, and sensitivity and specificity were compared to PSG results.Results: Among the 83 patients (30 males, 53 females; mean age 49.9 years), 27.7% had a history of smoking, 20.5% were diabetic, and 14.5% were hypertensive.Snoring (50.6%) was the most common symptom, followed by excessive daytime sleepiness (38.5%) and cough (21.7%).Obstructive sleep apnea was diagnosed in 75 patients apnea-hypopnea index (AHI) > 5, with 67 having severe OSA.Epworth Sleepiness Scale scores 11 were observed in 29 subjects, of whom 28 had OSA, yielding a sensitivity of 37.3% and specificity of 87.5%.The STOP-BANG scale identified OSA in 55 of 57 subjects with scores 3, achieving a sensitivity of 73.3% and specificity of 75%.The receiver operating characteristic (ROC) analysis showed moderate predictive value for STOP-BANG area under the curve (AUC) = 0.703 and higher accuracy for ESS (AUC = 0.833).The majority of subjects maintained a mean SpO 2 > 90%, with the lowest mean SpO 2 recorded at 66%. Conclusion:In an outpatient setting, the ESS can serve as a useful screening tool for identifying individuals at risk of OSA, particularly in populations with similar characteristics to those in this study.However, its effectiveness may be influenced by age-related biases.Therefore, while ESS can aid in initial assessment, a definitive diagnosis of OSA should only be made following PSG.

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