Implementing an educational program to increase preoperative screening for obstructive sleep apnea using the stop-bang questionnaire


  • Adam Davies University of North Florida
  • Monaghan W. Patrick University of North Florida
  • Hogan Gerard University of North Florida





Obstructive Sleep Apnea (OSA), STOP-BANG Questionnaire, Preoperative Screening, Anesthesia Complications, Technology acceptance model (TAM).


Background: Obstructive sleep apnea (OSA) is a potentially fatal disease process that has been linked to higher rates of morbidity and mortality as well as increased perioperative complications. OSA is characterized by repetitive pauses in breathing during sleep. Greater than 92% of women and 82% of men who are plagued by moderate to severe sleep apnea are undiagnosed and may go unrecognized in the perioperative setting. The gap between a high prevalence of undiagnosed OSA in the adult population and the low level of clinical recognition has been well-documented. The term “STOP-BANG†is an acronym for eight independent elements predictive of OSA—three are OSA-related symptoms, three are physiological measurements, and two are patient characteristics.

Methods: This project used a quasi-experimental design using a 16-question self-developed survey based on the technology acceptance model (TAM). Participants were asked to read an educational pamphlet on OSA and then complete the survey.

Results: This study found strong evidence to suggest that among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs), those with higher scores on Perceived Ease of Use (PEOU), Perceived Usefulness (PU), and Attitude toward Use (AT), tend to have a higher Behavioral Intention to Use (BIU) the STOP-BANG screening tool.

Conclusions: The results suggest that programs targeted at raising CRNAs’ and SRNAs’ PEOU, PU, and AT regarding the STOP-BANG questionnaire will culminate in increased use of the STOP-BANG screening tool. The use of this screening tool will detect patients previously unidentified as having OSA, and ultimately prevent perioperative complications associated with this disease.


[1] Cohen, J. (1988). Statistical Power Analysis for the Behavioral Science. New Jersey, Lawrence Erlbaum Associates, Inc. Lawrence Erlbaum Associates, Inc.; 365 Broadway; Hillsdale, New Jersey 07642

[2] Chung, F., Subramanyam, R., Liao, P., Sasaki, E., Shapiro, C., & Sun, Y. (2012). High STOP-BANG score indicates a high probability of obstructive sleep apnoea. British Journal of Anaesthesia, 108, 768–775.

[3] Chung, F., Yang, Y., & Liao, P. (2013). Predictive performance of the STOP-BANG score for identifying obstructive sleep apnea in obese patients. Obesity Surgery, 23, 2050-2057.

[4] Dolezal, D., Cullen, L., Harp, J., & Mueller, T. (2011). Implementing preoperative screening of undiagnosed obstructive sleep apnea. Journal of Perianesthesia Nursing, 26, 338–342.

[5] Farney, R. J., Walker, B., Farney, R. M., Snow, G., & Walker, J. (2011). The STOP-BANG equivalent model and prediction of severity of obstructive sleep apnea: Relation to polysomnnographic measurements of the apnea-hypopnea index. Journal of Clinical Sleep Medicine, 7, 459–465.

[6] Gali, B., Whalen, F., Schroeder, D., Gay, P., & Plevak, D. (2009). Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology, 110, 869–877.

[7] Gross, J., Bachenberg, K., Benumof, J., Caplan, R., Connis, R., Cote, C., Yu, S. (2006). Practice guidelines for the perioperative management of patients with obstructive sleep apnea: A report by the American Society of Anesthesiologists task force on perioperative management of patients with obstructive sleep apnea. Anesthesiology, 104, 1081–1093. Retrieved from

[8] Ha, S., Lee, D., Abdullah, V., & van Hasselt, C. (2014). Evaluation and validation of four translated Chinese questionnaires for obstructive sleep apnea patients in Hong Kong. Sleep and Breathing. Retrieved from

[9] Henrichs, B., & Walsh, R., (2012). Is that snoring something to worry about? Anesthetic implications for obstructive sleep apnea. AANA Journal, 80, 393–401. Retrieved from

[10] Hintze, J. (2008). PASS 2008 [Computer Software]. Kaysville, UT: NCSS, LLC.

[11] Kaw, R., Chung, F., Pasuleti, J., Mehta, J., Gay, P., & Hernandez, A. (2012). Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. British Journal of Anesthesia, 109, 897–906. doi:10.1093/bja/aes308

[12] Kulkarni, G. V., Horst, A., Eberhardt, J. M., Kumar, S., & Sarker, S. (2014). Obstructive sleep apnea in general surgery patients: Is it more common than we think? American Journal of Surgery, 207(3), 436–40.

[13] Luo, J., Huang, R., Zhong, X., Xiao, Y., & Zhou, J. (2014). STOP-BANG questionnaire is superior to Epworth sleepiness scales, Berlin questionnaire, and STOP questionnaire in screening obstructive sleep apnea hypopnea syndrome patients. Chinese Medical Journal, 127, 3065–3070. Retrieved from

[14] Mehta, P., Kochhar, G., Kalra, S., Maurer, W., Tetzlaff, J., Singh, G., Vargo, J. (2014). Can a validated sleep apnea scoring system predict cardiopulmonary events using propofol sedation for routine EGD or colonoscopy? A prospective cohort study. Gastrointestinal Endoscopy, 79, 436–444.

[15] Qaseem, A., Dallas, P., Owens, D., Starkey, M., Holty, J., & Shekelle, P. (2014). Diagnosis of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 16c, 210–220.

[16] Qualtrics. (2015). Qualtrics [Computer Software]. Provo, UT: Qualtrics, LLC.

[17] Silva, G. E., Vana, K. D., Goodwin, J. L., Sherrill, D. L., & Quan, S. F. (2011). Identification of patients with sleep disordered breathing: Comparing the four-variable screening tool, STOP, STOP-BANG, and epworth sleepiness scales. Journal of Clinical Sleep Medicine, 7, 467–472.

[18] Singh, M., Liao, P., Kobah, S., Wijeysundera, D., N., Shapiro, C., & Chung, F. (2013). Proportion of surgical patients with undiagnosed obstructive sleep apnoea. BJA: The British Journal of Anaesthesia, 110, 629–636.

[19] Vana, K., Silva, G., & Goldberg, R. (2013). Predictive abilities of the STOP-BANG and Epworth sleepiness scale in identifying sleep clinic patients at high risk for obstructive sleep apnea. Research in Nursing & Health, 36(1), 84–94.

[20] Vasu, T. S., Doghramji, K., Cavallazzi, R., Grewal, R., Hirani, A., Leiby, B., Witkowski, T. (2010). Obstructive sleep apnea syndrome and postoperative complications: Clinical use of the STOP-BANG questionnaire. Archives of Otolaryngology—Head & Neck Surgery, 136(10), 1020–1024.

[21] Young, T., Peppard, P., & Gottlieb, D. (2002). Epidemiology of obstructive sleep apnea: A population health perspective. American Journal of Respiratory & Critical Care Medicine, 165, 1217–1239. Retrieved from

View Full Article: