STOP-Bang score: how the eight items are counted

STOP-Bang counts eight yes/no items, 1 point each. The four STOP items are Snoring, Tiredness, Observed apnea and high blood Pressure. The four Bang items are BMI over 35, Age over 50, Neck over 40 cm and male Gender. The total runs from 0 to 8, and the calculator labels it 0-2 or >=3.

Not a medical device. Not a diagnosis or dosing recommendation.

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Respiratory calculators
Chung F et al. · 2008
The STOP-Bang formula
Worked examples
Frequently asked questions

What is STOP-Bang?

STOP-Bang is a short questionnaire for obstructive sleep apnea (OSA) from Frances Chung and colleagues, published in Anesthesiology in 2008. Their abstract describes four yes/no questions about snoring, daytime tiredness, observed apnea and high blood pressure, developed in surgical patients at preoperative clinics, and then combined with body mass index, age, neck size and gender.

Magent's calculator follows the version in Appendix 2 of that paper, with two bands. It isn't the later three-tier scheme.

This page explains the counting and the two band labels in the exact expression below. It doesn't say what a band means for a particular person.

The STOP-Bang formula

STOP-Bang = Snoring loudly            (1 if yes)
          + Tired during the day      (1 if yes)
          + Observed stopping breathing (1 if yes)
          + high blood Pressure       (1 if yes)
          + BMI over 35               (1 if yes)
          + Age over 50               (1 if yes)
          + Neck over 40 cm           (1 if yes)
          + male Gender               (1 if yes)
maximum = 8; bands 0-2 and 3 or more

Exact expression the calculator uses:

STOP-Bang = snoring + tired + observed_apnea + hypertension + (bmi_kg_m2>35) + (age>50) + (neck_cm>40) + male; each 1 if true; max 8; bands 0-2 / >=3

What each item means

Input	Scores 1 when
`snoring`	Loud snoring, heard through closed doors
`tired`	Daytime tiredness, fatigue or sleepiness
`observed_apnea`	Someone has seen the person stop breathing during sleep
`hypertension`	Has high blood pressure or is being treated for it
`bmi_kg_m2`	Body-mass index over 35 kg/m²
`age`	Age over 50 years
`neck_cm`	Neck circumference over 40 cm
`sex`	male

How the score works

Answer the four STOP questions true or false.
Enter BMI, age, neck size and sex. The calculator turns these into the four Bang points itself.
Add the eight items. The total is 0 to 8.
Read the band. The calculator labels 0 to 2 as 0-2 and 3 or more as >=3.

The cutoffs are strictly greater than

BMI, age and neck size score when they are above the cutoff, not at it. A BMI of 35, an age of 50 or a neck of 40 cm scores 0. The calculator takes BMI from 10 to 80, age from 18 to 120 and neck size from 20 to 80 cm, and sex as female or male. It doesn't work out BMI from height and weight, and it doesn't accept the Bang items as yes/no flags.

Worked examples

These use Magent's own expected values for the calculator. Unless stated, BMI is 30, age 40, neck 38 cm and sex female, so the four Bang items score 0. Each line adds the items in STOP-Bang order.

Example 1: no items

Score: 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0 = 0.
Band: 0-2.

Example 2: snoring, tired and observed apnea

Score: 1 + 1 + 1 + 0 + 0 + 0 + 0 + 0 = 3.
Band: >=3.

Example 3: BMI 36

BMI 36 is over 35 → 1.
Score: 0 + 0 + 0 + 0 + 1 + 0 + 0 + 0 = 1.
Band: 0-2.

Example 4: BMI 35

BMI 35 isn't over 35 → 0.
Score: 0 + 0 + 0 + 0 + 0 + 0 + 0 + 0 = 0.

Example 5: male, nothing else

Sex male → 1.
Score: 0 + 0 + 0 + 0 + 0 + 0 + 0 + 1 = 1.
Band: 0-2.

Values at the cutoffs

Each line changes one value in Example 1. All are Magent's expected values for the calculator.

Age 50 → 0; age 51 → 1.
Neck 40 cm → 0; neck 41 cm → 1.
BMI 35 → 0; BMI 36 → 1.

History of STOP-Bang

The calculator cites Chung F, Yegneswaran B, Liao P and colleagues, STOP questionnaire: a tool to screen patients for obstructive sleep apnea, Anesthesiology, 2008 (volume 108, issue 5, pages 812–821). The abstract describes the four STOP questions and their combination with body mass index, age, neck size and gender, which is the Bang part.

When it's used

The 2008 paper developed the questionnaire in surgical patients seen at preoperative clinics.

Where it's used

The 2008 study developed and checked the questionnaire in surgical patients at preoperative clinics, comparing it with overnight sleep studies (polysomnography).

Who uses it

The person using the calculator answers the four STOP questions and enters BMI, age, neck size and sex. The calculator works out the Bang points and the total.

Limits of the calculation

It counts eight items. It doesn't confirm or rule out sleep apnea.
It isn't a sleep-study order or an airway plan.
The STOP answers come from the user. The calculator doesn't question anyone.
It uses two bands, 0-2 and >=3. It isn't the later three-tier scheme.
This page doesn't say what to do with a score or band.

Clinical decisions belong to a qualified clinician who knows the patient.

STOP questionnaire: the four STOP questions alone, without the Bang items.
Three-tier STOP-Bang: a later version that splits the total into more groups. Magent's calculator uses the two bands from Appendix 2.
BMI is a separate calculator. STOP-Bang takes BMI as an input and doesn't compute it.

Glossary

OSA: obstructive sleep apnea, repeated blocking of the airway during sleep.
Apnea: a pause in breathing.
BMI: body-mass index, weight in kilograms divided by height in meters squared.
Neck circumference: the distance around the neck, in centimeters.

Common mistakes

Scoring BMI 35, age 50 or neck 40 cm. These don't score; the value has to be above the cutoff.
Entering Bang items as yes/no. Enter the BMI, age, neck size and sex; the calculator scores them.
Using the three-tier bands. This calculator labels totals 0-2 or >=3.
Entering neck size in inches. The input is centimeters.

Source

Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812-821. DOI: 10.1097/ALN.0b013e31816d83e4. PMID: 18431116

Frequently asked questions

How is STOP-Bang scored?

Each of the eight items is 1 point if present. Add them for a total of 0 to 8.

What does STOP-Bang stand for?

Snoring, Tired, Observed apnea, blood Pressure, BMI, Age, Neck and Gender.

Does a BMI of exactly 35 score a point?

No. BMI has to be above 35 to score. The same goes for age 50 and a neck of 40 cm.

What are the STOP-Bang bands?

The calculator labels totals of 0 to 2 as 0-2 and totals of 3 or more as >=3, as in its exact expression.