The comparison of STOP-BANG and no-apnea questionnaires in screening obstructive sleep apnea among commercial drivers

Objective: No-apnea questionnaire (NAQ) and STOP-BANG questionnaire (SBQ) are widely used for obstructive sleep apnea (OSA) screening. This investigation aimed to compare the SBQ with the NAQ as an OSA screening tool among commercial drivers.

Methods: We included eligible commercial drivers who came to the Occupational Health clinic between March 2018 and March 2019. Participants filled out the SBQ, NAQ, and ESS questionnaires. The SBQ scores eight factors to assess OSA risk, with a score of ≥3 indicating high risk. The NAQ scores age and neck circumference for OSA risk, with ≥3 indicating significant risk. The ESS measures daytime sleepiness, with a score of ≥10 indicating excessive sleepiness as the most common symptom of OSA. The patients' scores were evaluated based on the set criteria. A McNemar test was used to determine the differences between SBQ and NAQ. The number of at-risk patients was measured for each screening test, and the correlation between the two screening methods was evaluated by measuring Cohen's kappa coefficient.

Results: A total number of 581 commercial drivers, with a mean age of 44.39 ± 9.16 years, participated. The mean SBQ score was 1.82 ± 0.78, with 17.7% of participants being at high risk of OSA. The mean NAQ score was 3.48 ± 1.94, with 65.7% of participants being at high risk of OSA. About 48.6% of commercial drivers were at high risk, according to the NAQ but not SBQ. In contrast, 0.5% of participants were at high risk, according to SBQ, but not NAQ. Regarding ESS scores, among those identified as high risk for OSA by the SBQ, 13.6% exhibited an ESS score greater than 10. Similarly, within the high-risk group identified by the NAQ, this proportion was 14.1%. Cohen's kappa coefficient was 0.17, which is considerably low. A McNemar test also indicated that the SBQ and the NAQ didn't have equivalent diagnostic outcomes (P-value < 0.001).

Conclusions: The NAQ identified more professional drivers at risk for OSA compared to the SBQ, suggesting that objective-based questionnaires may be more effective for screening in safety-sensitive jobs like commercial driving. However, further validation with polysomnography and cost-benefit considerations are needed to determine the most efficient and sustainable screening approach.