Association between ASCVD risk score and STOP-BANG questionnaire for obstructive sleep apnea screening: a cross-sectional analysis

Patients may be less likely to be screened by their PCP for OSA compared to CVD. The ASCVD risk score and STOP-BANG questionnaire assess overlapping cardiometabolic risk factors. This study examined the correlation between ASCVD and STOP-BANG scores and whether combining them alters OSA screening performance compared to STOP-BANG alone. A cross-sectional secondary analysis of 201 participants (ages 40–75) from two National Sleep Research Resource datasets were utilized. Spearman correlations were calculated between ASCVD, STOP-BANG, and apnea–hypopnea index (AHI). Diagnostic performance metrics (sensitivity, specificity, positive and negative predictive values, likelihood ratios, area under the curve) were calculated for ASCVD (≥ 7.5%), STOP-BANG (≥ 3), and their combination for detecting at least mild OSA (AHI > 5). Univariable and multivariable logistic regression analyses assessed independent associations. ASCVD and STOP-BANG demonstrated strong correlation (r = 0.79, 95% CI 0.76–0.81). STOP-BANG showed superior sensitivity (0.91 vs. 0.52) compared to ASCVD. Combining ASCVD with STOP-BANG modestly improved specificity (0.66) and likelihood ratio (2.57) versus STOP-BANG alone. STOP-BANG, ASCVD, and the combined model demonstrated AUCs of 0.67, 0.64, and 0.77, respectively, with overlapping confidence intervals, indicating modest and not clearly different discrimination between models. In multivariable regression, only STOP-BANG remained significantly associated with OSA (OR 1.60 per point, 95% CI 1.30–1.97). ASCVD and STOP-BANG scores are strongly correlated, reflecting shared cardiometabolic risk factors. STOP-BANG remains the superior screening tool for OSA, whereas ASCVD appears to reflect overlapping risk burden without providing additional discriminatory value for OSA screening.