STOP-BANG for screening, Epworth for sleepiness, polysomnography to confirm
Expansion
STOP-BANG, one point each, with 3 or more suggesting risk:
- S - Snoring, loudly
- T - Tiredness during the day
- O - Observed apnoeas
- P - Pressure, treated hypertension
- B - BMI over 35
- A - Age over 50
- N - Neck circumference over 40 cm
- G - Gender male
Epworth Sleepiness Scale scores the chance of dozing in eight situations, out of 24; a score over 10 indicates excessive daytime sleepiness.
Diagnosis is by overnight oximetry or polysomnography, reported as the apnoea hypopnoea index: 5 to 14 mild, 15 to 30 moderate, over 30 severe.
Consequences: daytime sleepiness, road traffic accidents, resistant hypertension, atrial fibrillation, pulmonary hypertension, type 2 diabetes and reduced quality of life.
Management: weight loss, avoiding alcohol and sedatives at night, positional advice, and CPAP, which is the treatment of choice for moderate and severe disease. Mandibular advancement devices suit mild disease or CPAP intolerance.
The DVLA must be informed if there is excessive sleepiness affecting driving, and the patient must not drive until symptoms are controlled. This is a legal duty and should be documented.