STOP-BANG Calculator
Use our free STOP-BANG Calculator to get personalized health results. Based on validated medical formulas and clinical guidelines.
Reviewed for accuracy by Rahul Singh, Health & Wellness Specialist
Medical disclaimer: This calculator is provided for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. Results are general estimates and may not reflect your individual circumstances. Always consult a qualified healthcare professional before making decisions about your health.
STOP-BANG Calculator
Calculator
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Formula: STOP-BANG Score = Sum of 8 binary criteria (0 or 1 each, max 8)
Worked example — STOP-BANG: 8/8 | High Risk for OSA | Sleep study before elective surgery recommended
Formula
STOP-BANG Score = Sum of 8 binary criteria (0 or 1 each, max 8)
Eight yes/no criteria: Snoring (loud), Tired (daytime fatigue), Observed apneas, blood Pressure (treated hypertension), BMI > 35, Age > 50, Neck > 40 cm, Gender (male). Score 0-2: Low risk, 3-4: Intermediate risk, 5-8: High risk for moderate-to-severe OSA.
Worked Examples
Example 1: High-Risk Preoperative Patient
Problem:A 55-year-old male scheduled for knee surgery: loud snoring, daytime tiredness, wife observed apneas, on BP medication, BMI 38, neck 17 inches. Calculate STOP-BANG.
Solution:S - Snoring: YES (1) T - Tired: YES (1) O - Observed apneas: YES (1) P - Blood Pressure treatment: YES (1) B - BMI 38 > 35: YES (1) A - Age 55 > 50: YES (1) N - Neck 17 in = 43.2 cm > 40: YES (1) G - Male Gender: YES (1) Total Score: 8/8
Result:STOP-BANG: 8/8 | High Risk for OSA | Sleep study before elective surgery recommended
Example 2: Low-Risk Female Patient
Problem:A 35-year-old female: no snoring, occasional tiredness, no observed apneas, normal BP, BMI 24, neck 13.5 inches. Calculate STOP-BANG.
Solution:S - Snoring: NO (0) T - Tired: NO (0) O - Observed apneas: NO (0) P - Blood Pressure: NO (0) B - BMI 24 <= 35: NO (0) A - Age 35 <= 50: NO (0) N - Neck 13.5 in = 34.3 cm <= 40: NO (0) G - Female Gender: NO (0) Total Score: 0/8
Result:STOP-BANG: 0/8 | Low Risk for OSA | No further sleep evaluation needed
Frequently Asked Questions
What is the STOP-BANG questionnaire and what does it screen for?
The STOP-BANG questionnaire is a validated screening tool for obstructive sleep apnea (OSA) developed by Dr. Frances Chung at the University of Toronto in 2008. The acronym stands for eight binary (yes/no) risk factors: Snoring, Tiredness, Observed apneas, high blood Pressure, BMI over 35, Age over 50, Neck circumference over 40 cm, and male Gender. Each positive answer scores 1 point, for a total of 0 to 8. It was originally developed for preoperative screening of surgical patients but is now widely used in primary care and sleep medicine. The questionnaire takes less than 2 minutes to complete and has been validated in multiple languages and populations worldwide.
How are STOP-BANG scores interpreted for OSA risk?
STOP-BANG scores are categorized into three risk levels for moderate-to-severe obstructive sleep apnea. A score of 0 to 2 indicates low risk, with less than 10 percent probability of moderate-to-severe OSA. A score of 3 to 4 indicates intermediate risk, with approximately 25 to 35 percent probability. A score of 5 to 8 indicates high risk, with greater than 50 percent probability of moderate-to-severe OSA and greater than 70 percent probability of at least mild OSA. Additional high-risk criteria include a STOP score of 2 or more combined with either male gender, BMI over 35, or neck circumference over 40 cm. The sensitivity of STOP-BANG for moderate-to-severe OSA at a cutoff of 3 exceeds 90 percent.
Why is STOP-BANG used for preoperative screening?
Preoperative STOP-BANG screening is critical because undiagnosed obstructive sleep apnea significantly increases perioperative complications. Patients with undiagnosed OSA face a 2 to 4 times higher risk of postoperative respiratory complications including difficult intubation, oxygen desaturation, reintubation, and unplanned ICU admission. Sedatives, anesthetics, and opioid pain medications relax the upper airway and depress respiratory drive, worsening sleep apnea during and after surgery. The American Society of Anesthesiologists recommends preoperative OSA screening for all surgical patients. High-risk patients identified by STOP-BANG may benefit from preoperative CPAP therapy, modified anesthetic techniques, enhanced postoperative monitoring, and careful opioid management to reduce complications.
How does neck circumference relate to sleep apnea risk?
Neck circumference is one of the strongest physical predictors of obstructive sleep apnea because it reflects the amount of soft tissue surrounding the upper airway. A neck circumference greater than 40 cm (approximately 16 inches) in either sex is associated with significantly increased OSA risk. Excess adipose tissue around the neck compresses the pharyngeal airway during sleep when muscle tone naturally decreases, promoting airway collapse. Studies show that each 1 cm increase in neck circumference increases OSA risk by approximately 5 percent. Neck circumference correlates more strongly with OSA severity than body mass index alone because it specifically measures the tissue burden affecting the upper airway rather than overall body fat distribution.
Can women have sleep apnea even though male gender is a risk factor?
Absolutely. While male sex is a recognized risk factor and OSA is roughly 2 to 3 times more common in men than premenopausal women, sleep apnea in women is significantly underdiagnosed. Women with OSA often present with atypical symptoms such as insomnia, morning headaches, fatigue, depression, and anxiety rather than the classic loud snoring and witnessed apneas that characterize male OSA. After menopause, the gender gap narrows substantially as the protective effects of progesterone and estrogen on upper airway muscle tone diminish. Women with polycystic ovary syndrome, pregnancy, or obesity are at particularly elevated risk. Studies suggest that OSA may be underdiagnosed in up to 90 percent of women with moderate-to-severe disease due to atypical presentation and gender bias in clinical suspicion.
What is the relationship between BMI and obstructive sleep apnea?
Body mass index has a strong, dose-dependent relationship with obstructive sleep apnea. Each unit increase in BMI is associated with a 14 percent increase in OSA risk, and a 10 percent weight gain predicts an approximate 32 percent increase in AHI. Obesity contributes to OSA through multiple mechanisms: fat deposition around the pharyngeal airway directly narrows the upper airway lumen, abdominal obesity reduces lung volumes and functional residual capacity (decreasing tracheal tug on the airway), and adipose tissue produces inflammatory cytokines that may impair upper airway neuromuscular control. The STOP-BANG threshold of BMI greater than 35 identifies those with class II or higher obesity, who have the most significantly elevated OSA risk. Conversely, weight loss of 10 to 15 percent can reduce AHI by 30 to 50 percent.
How accurate is the STOP-BANG questionnaire compared to other screening tools?
The STOP-BANG questionnaire has been extensively validated and demonstrates superior sensitivity compared to other OSA screening tools. For detecting moderate-to-severe OSA (AHI >= 15), STOP-BANG has a sensitivity of 90 to 100 percent at a cutoff score of 3, meaning it catches nearly all cases. Its specificity is lower (25 to 45 percent), meaning some people without OSA will screen positive. Compared to the Berlin Questionnaire (sensitivity 69 to 87 percent), STOP questionnaire alone (sensitivity 74 to 83 percent), and the Epworth Sleepiness Scale (sensitivity 27 to 66 percent), STOP-BANG consistently demonstrates the highest sensitivity. The trade-off of high sensitivity for lower specificity is appropriate for a screening tool because missing cases (false negatives) is more dangerous than over-referring for sleep studies.
What should I do if my STOP-BANG score indicates high risk?
A high-risk STOP-BANG score (5 or above) should prompt several important next steps. First, schedule an appointment with your primary care physician or directly with a sleep medicine specialist to discuss your results and symptoms. Your doctor will likely order a diagnostic sleep study, either an in-laboratory polysomnography or a home sleep apnea test, to confirm the diagnosis and determine severity. In the interim, avoid sleeping on your back (supine position), limit alcohol consumption especially before bedtime, and avoid sedative medications when possible. If diagnosed with OSA, treatment options include CPAP therapy, oral appliance therapy, weight loss, positional therapy, and in some cases surgical interventions. Do not delay evaluation, as untreated OSA significantly increases cardiovascular and accident risks.
Does high blood pressure automatically mean sleep apnea?
While high blood pressure does not automatically indicate sleep apnea, there is a very strong bidirectional relationship between the two conditions. Approximately 50 to 60 percent of patients with OSA have hypertension, and 30 to 40 percent of hypertensive patients have undiagnosed OSA. OSA causes intermittent hypoxia and sympathetic nervous system activation during sleep, which leads to sustained elevation of blood pressure even during waking hours. Resistant hypertension (blood pressure that remains elevated despite three or more medications) is particularly associated with OSA, with prevalence rates of 70 to 83 percent. The STOP-BANG includes hypertension because it is both a consequence of and a red flag for sleep apnea. Treating OSA with CPAP can reduce blood pressure by 2 to 10 mmHg, with the greatest benefit in patients who use CPAP for more than 4 hours nightly.
Can the STOP-BANG questionnaire be used in children or adolescents?
The STOP-BANG questionnaire was developed and validated exclusively for adult populations and is not appropriate for use in children or adolescents under 18 years of age. Pediatric OSA has different risk factors, diagnostic thresholds, and underlying mechanisms compared to adult OSA. In children, the primary risk factor is adenotonsillar hypertrophy rather than obesity, and the AHI diagnostic threshold is 1 event per hour rather than 5. Pediatric screening tools include the Pediatric Sleep Questionnaire (PSQ) and the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire, both specifically validated for children. For adolescents transitioning to adult care, the STOP-BANG may become applicable at age 18, but clinicians should use clinical judgment when applying adult screening tools to older adolescents.
References
- Chung F et al. - STOP-BANG Questionnaire: A Practical Approach to Screen for OSA (Chest, 2016)
- Chung F et al. - STOP Questionnaire: A Tool to Screen Patients for Obstructive Sleep Apnea (Anesthesiology, 2008)
- American Society of Anesthesiologists - Practice Guidelines for Perioperative Management of OSA
Reviewed for accuracy by Rahul Singh, Health & Wellness Specialist · Editorial policy
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