Sleep apnea is very common
In the general population, 1 in 4 males and 1 in 10 females have at least mild obstructive sleep apnea. What about moderate or greater severity sleep apnea? In the general population, it occurs in 1 in 9 males and 1 in 20 females. (Source: stopbang.ca.) These are huge numbers!
Sleep apnea may be even more common in our patients
Sleep apnea may be particularly common in patients with mental disorders due to weight gain from psychotropic medications and an unhealthy lifestyle. Also, patients with sleep apnea can present with symptoms such as depression, insomnia, fatigue, poor concentration, etc.
So, mental health clinicians need to be excellent at identifying sleep apnea in our patients.
Most patients with sleep apnea go undiagnosed
Are we identifying these persons with moderate or severe sleep apnea? Overall (not specifically in mental health settings), about 82% of men and 92% of women with moderate or greater severity sleep apnea go UNDIAGNOSED! This is unacceptable.
What can we do?
The STOP-Bang questionnaire is routinely used by sleep medicine experts to screen patients for obstructive sleep apnea. However, it is rarely used by mental health professionals. This is unfortunate because sleep apnea is often present in patients with mental health problems, and the great majority of cases are missed!
The questionnaire is very simple to use and is free. It combines many of the clinical features that are used to screen persons for possible obstructive sleep apnea and then provides a score indicating the probability that the person has sleep apnea. If you start using the questionnaire right away, this will be a big step in the right direction for identifying among your patients those who may have sleep apnea.
STOP-Bang is an acronym as follows:
Snoring?
Tired? (Tired, fatigued, or sleepy during the daytime)
Observed? (Stop breathing or choking/ gasping during your sleep)
Pressure? (High blood pressure)
Body Mass Index
Age
Neck size
Gender
You can see the actual questionnaire, how it is scored, and how to interpret it at the links below.
Suggestion: Complete it for yourself first, just for practice.
Disclaimers:
1. The STOP-Bang Questionnaire is owned by University Health Network, Canada.
2. Use of the questionnaire is a tool and does not guarantee that all persons with sleep apnea will be identified.)
STOP-Bang Questionnaire online (patients can complete it online here)
STOP-Bang Questionnaire Home Page (link to the home page on its official site)
Related Pages
How to know if your patient snores if s/he sleeps alone!
Epworth Sleepiness Scale (my brief summary and link to the scale itself)
My tips on how to screen for sleep apnea
Sleep Log Questionnaire
Practical tips on using hypnotics: the Z drugs
Practical tips on using hypnotics: Benzodiazepines
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Thank you, Dr. Raj, for leading this discussion. It is an essential and critical point in the practice of sleep medicine. Connecting to a previous blog here about the RLS and the screening mnemonic URGE, I advise my colleagues to screen EVERY patient of chronic insomnia (more than 3 ms) with BOTH the URGE and STOP-BANG mnemonics before prescribing any sedative-hypnotic medication. As it is known that these medications are ineffective in these patient groups; instead the medications might be worsening their sleep difficulty and suffering. Most of the sedative-hypnotics relax upper airway muscles which worsens the OSA, or lower dopamine/raise serotonin which worsens the RLS. So, it is a wise step to rule out both OSA and RLS in patients of chronic insomnia, whether we prescribe labeled or off-label medications as sleep aids. In my practice of sleep medicine for years, I have encountered many patients of OSA or RLS who were put on antipsychotics or antidepressants for years without a clear benefit; instead, those patients got some relief after slowly tapering down these meds.