{'fraction_non_alphanumeric': 0.050946142649199416, 'fraction_numerical': 0.051431344007763224, 'mean_word_length': 4.792134831460674, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 1, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Diagnostic performance of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea in different ethnic groups.

STUDY OBJECTIVES
The STOP-Bang questionnaire is a concise and easy screening tool for obstructive sleep apnea (OSA). Using modified body mass index (BMI), we assessed the diagnostic performance of the STOP-Bang questionnaire in predicting OSA in different ethnic groups undergoing surgery.


METHODS
This was a multicentre prospective cohort study involving patients with cardiovascular risk factors undergoing major non-cardiac surgery. Patients underwent home sleep apnea testing. All patients completed the STOP-Bang questionnaire. The predictive parameters of STOP-Bang scores were calculated against apnea-hypopnea index (AHI).


RESULTS
1,205 patients from four ethnic groups (666 Chinese, 161 Indian, 195 Malay, and 183 Caucasian) were included in the study. The mean BMI ranged from 25 ± 4 to 30 ± 6 kg/m² and mean age ranged from 64 ±8 to 71 ±10 years. For the Chinese and Indian, diagnostic parameters were presented using BMI threshold of 27.5 kg/m² with the area under curve (AUC) to predict moderate-to-severe OSA were 0.709 (0.665-0.753) and 0.722 (0.635-0.808) respectively. For the Malay and Caucasian, diagnostic parameters were presented using BMI threshold of 35 kg/m² with the AUC for predicting moderate-to-severe OSA were 0.645 (0.572-0.720) and 0.657 (0.578-0.736) respectively. Balancing the sensitivity and specificity, the optimal STOP-Bang threshold for the Chinese, Indian, Malay and Caucasian were determined to be 4 or greater.


CONCLUSIONS
For predicting moderate-to-severe OSA, we recommend BMI threshold of 27.5 kg/m² for Chinese and Indian, and 35 kg/m² for Malay and Caucasian. The optimal STOP-Bang threshold for the Chinese, Indian, Malay and Caucasian is 4 or greater.


CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov, title: Postoperative Vascular Events in Unrecognised Obstructive Sleep Apnea, identifier: NCT01494181, URL: https://clinicaltrials.gov/ct2/show/study/NCT01494181.