European journal of obstetrics, gynecology, and reproductive biology · 2026
Diagnostic accuracy of the STOP-Bang questionnaire for obstructive sleep apnea in pregnancy: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Muhaisen Abdulrhman H M, Assaf Ayham, Aleidi Mohammad, Al-Rabba Faris, Al-Nayef Mohammad, Al-Natsheh Ibrahim, Qasaymeh Mahdi
Аннотация
BACKGROUND: Obstructive sleep apnea (OSA) in pregnancy is associated with adverse maternal and perinatal outcomes, yet timely diagnostic testing can be limited. Screening questionnaires such as STOP-Bang are therefore used to triage patients for objective testing.
OBJECTIVE: To synthesize evidence on the diagnostic accuracy of the STOP-Bang questionnaire for detecting OSA in pregnancy.
METHODS: We conducted a PRISMA 2020-compliant systematic review (PROSPERO: CRD420261297348). PubMed, Scopus, Web of Science, and EBSCOhost databases were searched from inception through February 2026. Eligible studies evaluated STOP-Bang in pregnant participants against polysomnography (PSG) or home sleep apnea testing (HSAT)/portable monitoring. The risk of bias was assessed using the QUADAS-2. When ≥ 2 studies provided complete (or derivable) 2 × 2 data at STOP-Bang ≥ 3 and AHI/REI ≥ 5, we performed a hierarchical bivariate random-effects diagnostic meta-analysis (Reitsma model; REML) to pool sensitivity and specificity jointly; pathway-based partial verification studies were synthesized narratively.
RESULTS: Five cohort studies (2015-2024) comprising 1,096 pregnant participants were included; 573 underwent objective sleep testing. Reference standards were predominantly HSAT/portable monitoring, with limited PSG in a small subset in one study. Reported diagnostic performance varied across studies, with sensitivity ranging from approximately 0.53 to 0.63 and specificity from 0.36 to 0.90 [1-3], and individual-study AUC values ranging from approximately 0.63 to 0.75. Studies embedded within referral pathways or with partial verification yielded less stable and potentially biased estimates. QUADAS-2 identified flow and timing as the most frequent concern due to partial verification/work-up bias. Hierarchical meta-analysis (STOP-Bang ≥ 3; AHI/REI ≥ 5) yielded pooled sensitivity 0.587 (95% CI 0.464-0.699) and pooled specificity 0.749 (95% CI 0.360-0.941), with AUC 0.604. In sensitivity analysis excluding a class III obesity cohort, pooled specificity increased to 0.860 and AUC to 0.832, while pooled sensitivity remained similar (0.566). Sensitivity was relatively consistent across studies, whereas specificity varied widely.
CONCLUSION: Current evidence does not support STOP-Bang as a reliable stand-alone screening tool for obstructive sleep apnea in pregnancy. Its diagnostic performance appears variable and generally modest, and pregnant patients with suspected OSA should undergo objective sleep evaluation.
OBJECTIVE: To synthesize evidence on the diagnostic accuracy of the STOP-Bang questionnaire for detecting OSA in pregnancy.
METHODS: We conducted a PRISMA 2020-compliant systematic review (PROSPERO: CRD420261297348). PubMed, Scopus, Web of Science, and EBSCOhost databases were searched from inception through February 2026. Eligible studies evaluated STOP-Bang in pregnant participants against polysomnography (PSG) or home sleep apnea testing (HSAT)/portable monitoring. The risk of bias was assessed using the QUADAS-2. When ≥ 2 studies provided complete (or derivable) 2 × 2 data at STOP-Bang ≥ 3 and AHI/REI ≥ 5, we performed a hierarchical bivariate random-effects diagnostic meta-analysis (Reitsma model; REML) to pool sensitivity and specificity jointly; pathway-based partial verification studies were synthesized narratively.
RESULTS: Five cohort studies (2015-2024) comprising 1,096 pregnant participants were included; 573 underwent objective sleep testing. Reference standards were predominantly HSAT/portable monitoring, with limited PSG in a small subset in one study. Reported diagnostic performance varied across studies, with sensitivity ranging from approximately 0.53 to 0.63 and specificity from 0.36 to 0.90 [1-3], and individual-study AUC values ranging from approximately 0.63 to 0.75. Studies embedded within referral pathways or with partial verification yielded less stable and potentially biased estimates. QUADAS-2 identified flow and timing as the most frequent concern due to partial verification/work-up bias. Hierarchical meta-analysis (STOP-Bang ≥ 3; AHI/REI ≥ 5) yielded pooled sensitivity 0.587 (95% CI 0.464-0.699) and pooled specificity 0.749 (95% CI 0.360-0.941), with AUC 0.604. In sensitivity analysis excluding a class III obesity cohort, pooled specificity increased to 0.860 and AUC to 0.832, while pooled sensitivity remained similar (0.566). Sensitivity was relatively consistent across studies, whereas specificity varied widely.
CONCLUSION: Current evidence does not support STOP-Bang as a reliable stand-alone screening tool for obstructive sleep apnea in pregnancy. Its diagnostic performance appears variable and generally modest, and pregnant patients with suspected OSA should undergo objective sleep evaluation.