The following article is part of coverage from the American Academy of Neurology’s Annual Meeting (AAN 2020). Due to the global COVID-19 pandemic, the Academy made the necessary decision to cancel the meeting originally scheduled for April 25–May 1, 2020, in Toronto. While live events will not proceed as planned, readers can click here catch up on the latest research intended to be presented at the meeting.

The STOPBAG2 scoring instrument, which incorporates sleep-related symptoms and continuous variables for age and body mass index (BMI), offers greater discriminatory power for predicting all levels of obstructive sleep apnea (OSA) severity in adults with epilepsy compared with abbreviated and modified versions of the scoring system. This is according to research intended to be presented at the annual meeting of the American Academy of Neurology (AAN 2020).

The STOP (Snoring, Tiredness/sleepiness/fatigue, Observed apneas, high blood Pressure), STOP-BANG (STOP, BMI ≥30kg/m, Age ≥50 years, Neck circumference ≥40cm, and Male gender), and STOPBAG are screening instruments for OSA. The STOPBAG2, which includes STOP and male sex as well as continuous variables for age and BMI, is a modified version of the instruments. A greater score from these instruments indicates higher OSA risk.

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In this study, researchers calculated scores for STOP, STOPBANG, STOPBAG, and STOPBAG2 in 133 adults with epilepsy (age, 41.9±13.7 years) who underwent polysomnography. Disease severity was assessed by the apnea-hypopnea index (AHI). Severity was defined as mild (AHA: 5≤15 [32%]), moderate (AHI: 15≤30 [19%]), or severe (AHI: >30 [17%]). Overall, all screening instruments highly correlated with severity of OSA (P <.001 for all).

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Compared with the STOP, STOPBANG, and STOPBAG instruments, the STOPBAG2 offered the best sensitivity for predicting each level of OSA severity, including mild (0.86), moderate (0.79), severe (0.82). The STOPBAG2 also featured the best specificity for predicting mild OSA (0.86); however, specificity of this instrument was comparable to the other versions for predicting moderate and severe OSA. Additionally, the STOPBAG2 featured the greatest receiver operating characteristic discriminatory power for each OSA severity level, including mild (0.90), moderate (0.78), and severe (0.80) OSA.

The findings that STOPBAG2 offered “the greatest discriminatory power for predicting all levels of severity” of OSA support “its implementation in epilepsy clinics,” the researchers suggest.


Pascoe M, Andrews N, Bena J, Katzan I, Foldvary-Schaefer N. Comparison of screening instruments for obstructive sleep apnea in adults with epilepsy. Intended to be presented at the 2020 annual meeting of the American Academy of Neurology. 

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