The Sleep Score Showdown: Mallampati, STOP-BANG, Epworth Sleepiness Scale Versus the Apnea–Hypopnea Index Standard in Assessing the Severity of Obstructive Sleep Apnea

Context: Obstructive sleep apnea (OSA) poses significant health risks, with the Apnea–Hypopnea Index (AHI) from polysomnography serving as the diagnostic gold standard. Due to limited access, screening tools such as the Mallampati classification, STOP-BANG questionnaire, and Epworth Sleepiness Scale (ESS) are commonly used. Aim: This study evaluates and compares these screening tools and their correlation with AHI to determine their effectiveness in assessing OSA severity, aiming to enhance patient evaluation and guide diagnostic prioritization. Materials and Methods: A 1-year prospective observational study was conducted on 52 patients clinically suspected of OSA based on symptoms such as snoring, daytime sleepiness, witnessed apneas, and nonrestorative sleep. Each patient was evaluated using the Mallampati classification (I–IV), STOP-BANG questionnaire (0–8), and ESS (0–24), followed by a level 3 sleep study to determine the AHI. The scores of these screening tools were statistically correlated with AHI using Pearson’s and Spearman’s correlation coefficients to assess their predictive accuracy for OSA severity. Statistical Analysis: Pearson and Spearman’s coefficient, Fisher’s r -to- z transformation, multivariable linear regression analysis, and receiver operating characteristic curve analysis. Results: Among the 52 patients, Pearson’s correlation revealed a significant large positive relationship between Mallampati score and AHI ( r = 0.7748, P < 0.001) and between STOP-BANG and AHI ( r = 0.5866, P < 0.001). ESS showed a moderate positive correlation with AHI ( r = 0.3659, P = 0.008). Neck circumference emerged as the strongest independent predictor of AHI. Conclusion: Mallampati score demonstrated the strongest association with OSA severity (especially in detecting moderate to severe OSA), followed by STOP-BANG and then ESS.