Assessment of Elements of STOP-BANG Questionnaire in Screening Obstructive Sleep Apnea (OSA) in Iranian Commercial Drivers

Background and Objective: Sleepiness is one of the important factors in motor vehicle accidents, especially in commercial drivers (CDs). Obstructive sleep apnea (OSA) has an important role in developing sleepiness. The STOP-BANG questionnaire is used in medical examinations of commercial drivers in Iran by law. This study aimed to investigate the judgment that drivers prefer not to report their symptoms honestly leading to underestimation of their STOP-BANG scores. Materials and Methods: In a cross-sectional study, two groups of commercial drivers were compared; A: 52 drivers referred from Occupational Medicine Clinic to Baharloo Sleep Clinic, Tehran, Iran, because of detecting high scores in the STOP-BANG questionnaire with confirmed obstructive sleep apnea in the polysomnography, B: 87 volunteer commercial drivers referred to Baharloo Sleep Clinic because of sleep related complaints and obstructive sleep apnea was confirmed via polysomnography. The score of Epworth Sleepiness Scale (ESS) and the subjective items including snoring, tiredness, and observed apnea (STO) and objective items including blood pressure, body mass index (BMI), neck circumference, age, and gender (P-BANG) were compared between the groups and the correlations with Apnea/Hypopnea Index (AHI) were assessed. Results: Statistical analysis showed that STO scores were different between the two groups (P 0.0001). Mean STO score was 0.80 for Group A and 1.75 for Group B. The STO of group A showed a negative correlation with Apnea/ Hypopnea Index (Correlation Coefficient = -0.1240). On the contrary, the STO score for group B was correlated with Apnea/Hypopnea Index (Correlation Coefficient = 0.4432). Conclusion: Subjective items of STOP-BANG questionnaire in commercial drivers requesting health license require re-evaluation. New cut-off criterion or combination with more objective methods is recommended to be considered for screening of obstructive sleep apnea in commercial drivers.