The STOP-BANG score is an eight-item screening tool that estimates the risk of obstructive sleep apnea (OSA) from snoring, daytime tiredness, observed apneas, blood pressure, body mass index, age, neck size, and gender. Each yes answer adds one point (total 0–8). Higher totals mean higher OSA risk and usually prompt further sleep evaluation rather than a stand-alone diagnosis. Use the free STOP-BANG score calculator to total the items, then interpret the result with clinical judgment.
Definitions
| Term | Meaning |
|---|---|
| STOP-BANG | Eight-item OSA screening questionnaire; letters stand for Snoring, Tiredness, Observed apnea, Pressure (hypertension), BMI, Age, Neck circumference, Gender |
| Obstructive sleep apnea (OSA) | Repeated upper-airway collapse during sleep that causes breathing pauses and fragmented sleep |
| Screening score | A triage aid that ranks risk; it does not confirm or exclude OSA by itself |
| High risk | Commonly interpreted as a total of 5–8, or a STOP of 2 plus certain Bang features (see bands below) |
| Polysomnography | Overnight sleep study used to diagnose OSA and grade severity |
What does each STOP-BANG item ask?
STOP covers symptoms and blood pressure history. BANG covers body size and demographics.
STOP
- Snoring – Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
- Tired – Do you often feel tired, fatigued, or sleepy during the daytime?
- Observed – Has anyone observed you stop breathing or choking/gasping during sleep?
- Pressure – Do you have (or are you being treated for) high blood pressure?
BANG
- BMI – Is body mass index more than 35 kg/m²?
- Age – Are you older than 50 years?
- Neck – Is neck circumference large (commonly >40 cm / about 16 inches in many clinic versions)?
- Gender – Are you male?
Score 1 for each “yes,” 0 for each “no.” The sum is 0 to 8. Confirm BMI with a reliable BMI calculator when height and weight are available, then return to the STOP-BANG total.
How do you interpret STOP-BANG results?
Interpretation varies slightly by guideline and clinic pathway. A widely taught three-band map is:
| Score | Typical risk label | Practical next step |
|---|---|---|
| 0–2 | Low risk | Lifestyle advice and reassess if symptoms change |
| 3–4 | Intermediate risk | Consider further evaluation, especially if symptoms are strong |
| 5–8 | High risk | Prioritize sleep specialist referral or diagnostic testing |
Some pathways also treat a patient as high risk when the STOP section scores 2 or more and BMI >35, male gender, or large neck circumference is present, even if the total is only intermediate. Always follow your local sleep pathway.
A high score raises concern for OSA. A low score does not rule out every sleep disorder. Daytime sleepiness can also be tracked with the Epworth Sleepiness Scale alongside STOP-BANG when you need a fuller symptom picture.
When should you escalate after a STOP-BANG screen?
Escalate or refer earlier when:
- The total is high (often 5–8) or local rules flag high risk
- There is witnessed apnea, gasping, or refractory hypertension
- The person has unexplained daytime sleepiness that impairs driving or work safety
- There is heart failure, atrial fibrillation, stroke history, or planned major surgery where untreated OSA may raise perioperative risk
- Symptoms worsen despite weight loss or CPAP is already indicated by a prior study
Safety comes first. Someone who falls asleep while driving needs urgent clinical review, not another checklist alone.
What are the limitations of STOP-BANG?
It is a screen, not a diagnosis. Only a sleep study (or an approved home sleep apnea test in the right setting) confirms OSA and severity.
Cutoffs are population averages. Performance can differ by sex, age, ethnicity, and clinic mix. Neck circumference thresholds are not identical in every published version, so use the cutoffs your service adopts.
False reassurance is possible. Mild OSA, positional OSA, or central sleep apnea may still exist with a modest score. False alarms happen too: loud snoring without apnea, insomnia, depression, medication effects, and shift work can raise tiredness scores.
BMI and neck size change slowly; symptom items can change faster after weight loss, alcohol reduction, or nasal congestion treatment. Re-score when the clinical picture shifts.
How should you use STOP-BANG in practice?
- Ask the eight items clearly, or have the patient complete them.
- Measure or calculate BMI; measure neck circumference when your pathway requires it.
- Total the score with the STOP-BANG calculator.
- Map the band and compare with daytime function (Epworth can help).
- Agree next steps: watchful waiting, lifestyle change, primary-care follow-up, or sleep referral/testing.
- Document the total, key positive items, and the shared plan.
What is a normal STOP-BANG score?
Scores of 0–2 are usually labeled low risk when history and exam fit. “Low risk” is not the same as “no sleep problem.” New snoring, choking, or dangerous sleepiness still needs review.
Is a STOP-BANG of 3 enough for a sleep study?
A total of 3–4 is often intermediate risk. Many clinics still pursue testing when symptoms are strong, cardiovascular disease is present, or surgery is planned. Local criteria decide, not the number alone.
Does STOP-BANG diagnose sleep apnea?
No. It estimates pretest risk. Diagnosis needs appropriate sleep testing and clinical interpretation.
Can women use STOP-BANG?
Yes. Gender is one scored item, and women can still score high on the other seven. Some research notes under-recognition of OSA in women, so take symptoms seriously even when the total is only intermediate.
How is STOP-BANG different from the Epworth scale?
STOP-BANG targets OSA risk features. Epworth rates how likely someone is to doze in everyday situations. They complement each other; neither replaces a sleep study.
Medical disclaimer
This article is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. The STOP-BANG score is a clinical screening aid; results must be interpreted by a qualified healthcare professional. If you have dangerous daytime sleepiness, chest pain, or breathing difficulty, seek urgent medical care. Do not delay care based on an online score alone.