STOP-BANG Score: What It Means and How to Calculate Yours

The STOP-BANG questionnaire is one of the most validated, widely-used clinical screening tools for obstructive sleep apnea. Developed by Dr. Frances Chung at the University of Toronto, it's used in hospital pre-admission screening worldwide. Here's what it actually measures — and what your score means.

The 8 Questions (and What They're Actually Measuring)

S — Snoring

"Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?"

Loud snoring is caused by partial airway obstruction during sleep — the hallmark of OSA. Not all snorers have apnea, but most people with OSA snore. The threshold here is "louder than talking," which excludes light social snoring.

T — Tired

"Do you often feel tired, fatigued, or sleepy during the daytime?"

When sleep apnea causes your airway to collapse repeatedly through the night, you wake briefly (often without knowing it) each time. The result is fragmented sleep that leaves you chronically unrefreshed — even after 8 hours in bed. Excessive daytime sleepiness is one of the most common complaints from undiagnosed OSA patients.

O — Observed

"Has anyone observed you stop breathing during your sleep?"

Witnessed apneas — a bed partner watching you stop breathing for 10+ seconds — are among the strongest clinical predictors of OSA. If someone has noticed this, it's a significant signal regardless of your other answers.

P — Pressure

"Do you have or are you being treated for high blood pressure?"

Untreated OSA causes repeated nighttime oxygen drops and sympathetic nervous system surges that raise blood pressure over time. Hypertension and sleep apnea co-occur frequently — up to 50% of people with hypertension have OSA.

B — BMI

"Is your BMI more than 35 kg/m²?"

Excess weight, particularly fat deposits around the neck and upper airway, increases the mechanical tendency for airway collapse. A BMI over 35 significantly elevates OSA risk. Formula: BMI = weight(kg) / height(m)²

A — Age

"Are you older than 50 years?"

OSA prevalence increases with age as upper airway muscle tone decreases. The age threshold of 50 is the validated cutoff from the original Chung et al. study.

N — Neck Circumference

"Is your neck circumference greater than 40 cm (women) or 43 cm (men)?"

A larger neck circumference indicates more soft tissue around the airway. This is measured at the level of the thyroid cartilage (Adam's apple). Measure with a flexible tape measure: women >40.6 cm (16 in), men >43.2 cm (17 in) = positive.

G — Gender

"Are you male?"

Men are 2–3 times more likely to have OSA than pre-menopausal women, due to differences in fat distribution, airway anatomy, and hormonal effects on airway muscle tone. Post-menopausal women's risk approaches men's — but the questionnaire doesn't distinguish, so it uses a simple male = +1 criterion.

How to Score Yourself

Each "Yes" answer = 1 point. Maximum score: 8.

Score	Risk Level	What This Means
0–2	🟢 Low Risk	Low probability of moderate-severe OSA. Continue monitoring; see a doctor if symptoms develop.
3–4	🟡 Intermediate Risk	Moderate probability of OSA. Consider discussing with your doctor, especially if you have daytime symptoms.
5–8	🔴 High Risk	High probability of moderate-severe OSA. Seek evaluation — a sleep study is strongly recommended.

The Evidence Behind the Numbers

The STOP-BANG questionnaire was validated in a surgical population of 2,467 patients by Chung et al. (Anesthesiology, 2008). In that study:

• Sensitivity for moderate-severe OSA (AHI ≥15): 93%
• Sensitivity for severe OSA (AHI ≥30): 100%
• Negative predictive value at score 0–2: 90%+

This means the tool is excellent at ruling out severe OSA (a score of 0–2 almost certainly means you don't have severe disease), and very good at identifying high-risk individuals. It's intentionally designed to over-refer rather than miss cases.

What STOP-BANG Doesn't Capture

STOP-BANG is a self-report questionnaire with 8 binary items. It doesn't capture:

• Severity of snoring or observed pauses (duration, frequency)
• Nasal obstruction or congestion
• Positional changes in symptoms (worse on back)
• Alcohol or sedative use effects
• Menopausal status in women

This is why the Mallampati throat assessment is used as a supplementary indicator — upper airway anatomy provides additional clinical information beyond what self-report can capture.

Next Steps If Your Score Is High

1. See your primary care physician and share your score
2. Request a referral to a sleep specialist or sleep study (polysomnography)
3. In the meantime: sleep on your side, avoid alcohol within 3 hours of bedtime, maintain healthy weight
4. Do not start CPAP therapy without a formal diagnosis — pressure settings require calibration to your specific apnea pattern

References: Chung F et al. Anesthesiology 2008;108(5):812-821. Chung F et al. Br J Anaesth 2012;108(5):768-775. For informational purposes only — not a medical diagnosis.