Optimizing Screening for Obstructive Sleep Apnea: Comparative Assessment of STOP and STOP-Bang Questionnaires in Croatia, Türkiye, and Greece

Background and Objectives: We aimed to analyze the screening accuracy of the STOP and STOP-Bang questionnaires within three distinct populations from the Mediterranean region: Croatia, Greece, and Türkiye. Additionally, we aimed to optimize previously suggested and to establish population-specific cut-off points for body mass index (BMI) and neck circumference (NC) in the questionnaires to enhance their screening accuracy. Materials and Methods: A total of 9,102 patients who underwent polysomnography or polygraphy to evaluate suspected OSA were enrolled from: Split Sleep Medicine Centre (Croatia), Ege University Faculty of Medicine (Türkiye), and Thessaloniki G Papaniko-laou Hospital Aristotle University (Greece). Patients completed the STOP and STOP-Bang questionnaires before sleep assessments. Sensitivity, specificity, and area under the curve (AUC) were calculated to assess the screening properties. Additionally, optimized cut-offs for age, NC, and BMI were determined. Results: The highest AUC values were observed using the STOP-Bang≥5 method, with AUC values of 0.712 for detecting any OSA (AHI≥5/h), 0.684 for moderate or severe OSA (AHI≥15/h), and 0.663 for severe OSA (AHI≥30/h). For individual centers, the STOP-Bang≥5 method performed best in Split, while the STOP≥2+NC method yielded the highest AUCs in Izmir and Thessaloniki for moderate and severe OSA. Optimized cut-off values for age, NC, and BMI improved sensitivity and specificity across all cen-ters. Conclusions: This study highlights the necessity of population-specific considerations in the screening of OSA. Significant differences in demographics, anthropometrics, symptoms, and comorbidities across populations could impact the questionnaire's screening accuracy. Adjusting age, NC, and BMI cut-off points optimizes the STOP-Bang questionnaire.