STOP-BANG SCREENING IN HYPERTENSIVE PATIENTS WITH SUSPECTED OSA: EVIDENCE FOR URGENT POLYSOMNOGRAPHY REFERRAL FROM PAKISTAN

Abstract

Background: Obstructive sleep apnea (OSA) and systemic hypertension share a bidirectional, mechanistically defined relationship underpinned by intermittent nocturnal hypoxia and chronic sympathetic hyperactivation. Despite compelling pathophysiological evidence, systematic OSA screening in hypertensive patients remains inconsistent in resource-limited settings. The STOP-Bang questionnaire is the most widely validated pre-polysomnography OSA screening instrument, with pooled sensitivity exceeding 92% for moderate-to-severe disease (Nagappa et al., 2015). Objective: To determine whether hypertension independently predicts high-risk OSA classification on the STOP-Bang questionnaire and to assess implications for urgent polysomnography (PSG) referral prioritisation in this subgroup. Methods: A cross-sectional study was conducted at the Sleep Laboratory, Khyber Teaching Hospital (KTH), Peshawar. One hundred and three consecutively referred adults completed the STOP-Bang questionnaire prior to overnight PSG. Hypertension status was the primary predictor variable. Associations with STOP-Bang risk category were assessed using Pearson chi-square analysis and multivariable linear regression (p < 0.05). Results: Hypertension was present in 68.0% of participants and was the only variable significantly associated with STOP-Bang risk category (χ² = 6.635, df = 2, p = 0.036). Among hypertensive patients, 74.3% were classified High Risk versus 48.5% of non-hypertensive patients — a 25.8 percentage-point excess. Hypertension was the sole independent predictor of OSA risk classification in regression analysis (β = 0.38, SE = 0.17, p = 0.036; R² = 0.61). Conclusion: Hypertension is an independent, statistically robust predictor of high-risk OSA on STOP-Bang screening. Hypertensive patients presenting with OSA symptoms should be prioritised for urgent polysomnography, given their markedly elevated a priori probability of clinically significant sleep-disordered breathing. Routine STOP-Bang integration into hypertension care pathways is evidence-based and immediately implementable.

Keywords: Obstructive sleep apnea · STOP-Bang· Hypertension · Polysomnography · OSA screening · Sleep-disordered breathing · Pakistan · Cardiovascular comorbidity