Optimizing Screening for Obstructive Sleep Apnea: Comparative Assessment of STOP and STOP-BANG Questionnaires in Croatia, Türkiye, and Greece

Background and Objectives: Obstructive sleep apnea (OSA) is a common disorder associated with significant cardiovascular, metabolic, and neurocognitive consequences. The STOP and STOP-BANG questionnaires are widely used screening tools for identifying individuals at increased risk of OSA. However, their performance may vary across populations. This variability is due to demographic and anthropometric differences. We aimed to analyze the screening accuracy of the STOP and STOP-BANG questionnaires across three distinct Mediterranean populations: Croatia, Greece, and Türkiye. Additionally, we aimed to optimize and establish population-specific cut-off points for body mass index (BMI) and neck circumference (NC) in the questionnaires to enhance their screening accuracy. Materials and Methods: A total of 9102 patients who underwent polysomnography or polygraphy to evaluate suspected OSA were enrolled from: Split Sleep Medicine Centre (Croatia), Ege University Faculty of Medicine (Türkiye), and Thessaloniki G Papanikolaou Hospital Aristotle University (Greece). Patients completed the STOP and STOP-BANG questionnaires before sleep assessments. Sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) were calculated to assess the screening properties. Additionally, optimized cut-offs for age, NC, and BMI were determined. Results: The highest AUC values were observed using the STOP-BANG ≥ 5 method, with AUC values of 0.712 for detecting any OSA (AHI ≥ 5/h), 0.684 for moderate or severe OSA (AHI ≥ 15/h), and 0.663 for severe OSA (AHI ≥ 30/h). For individual centers, the STOP-BANG ≥ 5 method performed best in Split, while the STOP ≥ 2 + NC method yielded the highest AUCs in Izmir and Thessaloniki for moderate and severe OSA. Optimized cut-off values for age, NC, and BMI improved sensitivity and specificity across all centers. Conclusions: This study highlights the need for population-specific considerations in the screening for OSA. Significant differences in demographics, anthropometrics, symptoms, and comorbidities across populations could impact the questionnaire’s screening accuracy. Adjusting age, NC, and BMI cut-off points optimizes the STOP-BANG questionnaire.