Sleep Apnea Screening Epilepsy: What This Study Found

What was studied

Researchers studied 724 adults with epilepsy who had STOP-BANG information available within one year of an overnight sleep study. They compared five related screening methods: STOP, STOP-BANG, STOP-BAG, STOP-BAG2, and a reweighted STOP-BANG2.

The main outcome was obstructive sleep apnea defined as an apnea-hypopnea index of at least 5 on the sleep study. The researchers also assessed seizure frequency and severity, but the abstract does not report findings involving those measures.

What they found

Higher STOP, STOP-BANG, STOP-BAG, and STOP-BAG2 scores were associated with obstructive sleep apnea. STOP-BAG2 and STOP-BANG2 showed the strongest predictive performance, but their ability to distinguish people with and without sleep apnea was limited to moderate; each had an area under the curve of 0.70.

At the selected cutoff, STOP-BAG2 had 67% sensitivity and 65% specificity. STOP-BANG2 had 72% sensitivity and 60% specificity. STOP-BAG2 performed better than STOP-BANG and STOP-BAG and did not differ significantly from STOP-BANG2. Improvements from the continuous weighted models over categorical scores were modest.

Limits of the evidence

The screening tools showed limited-to-moderate discrimination compared with sleep-study-defined obstructive sleep apnea. At the selected cutoffs, they would miss a clinically relevant portion of cases and would also classify some people without sleep apnea as being at risk. Validation was internal, using bootstrap resampling, rather than conducted in a separate patient group. The abstract does not provide participant demographics, recruitment setting, sleep apnea prevalence, or findings related to seizure severity and frequency.

For families and caregivers

Obstructive sleep apnea can occur alongside epilepsy and may be overlooked. These questionnaires may help estimate which adults are at risk, but they do not identify every case. Screening results should be interpreted cautiously and are not the same as a diagnosis based on a sleep study.

What to watch next

Further studies could test the best-performing tools in separate and diverse groups of adults with epilepsy. Research could also examine their performance when screening information and sleep studies are collected close together.

Terms in this summary

Obstructive sleep apnea (OSA)

Repeated narrowing or blockage of the airway during sleep, causing pauses or reductions in breathing.

Comorbidity

A health condition that occurs alongside another condition, such as sleep apnea occurring with epilepsy.

Polysomnography (PSG)

An overnight sleep study that records breathing and other body functions during sleep.

Apnea-hypopnea index (AHI)

The average number of complete or partial breathing interruptions per hour of sleep.

Sensitivity

The percentage of people with the condition who are correctly identified by a screening tool.

Specificity

The percentage of people without the condition who are correctly classified by a screening tool.

Area under the curve (AUC)

A measure of how well a test distinguishes people with and without a condition; 0.5 indicates chance-level performance and 1.0 indicates perfect discrimination.

Youden cutoff

A selected test-score threshold intended to balance sensitivity and specificity.