B-APNEIC: A New Screening Tool for Severe Obstructive Sleep Apnea in the Preoperative Setting

A more objective screening for severe OSA, with less "self-report" and greater reproducibility.

Key takeaways#

Why this matters perioperatively

• Obstructive sleep apnea (OSA) is common perioperatively and, when severe cases go unrecognized, increases risk of desaturation, airway obstruction, and respiratory/cardiovascular events.

What is B-APNEIC and how it "shortens" STOP-BANG

• B-APNEIC simplifies STOP-BANG to 4 items, with greater weight for neck circumference, and uses a cutoff ≥ 3 to suggest higher probability of severe OSA.

What the study suggests about diagnostic performance

• In the Australian study (sleep clinic), B-APNEIC ≥ 3 had 84% sensitivity and 86% NPV for severe OSA (AHI ≥ 30), suggesting practical utility to "rule out severe OSA" when < 3.
• In head-to-head comparison, B-APNEIC outperformed STOP-BANG ≥ 5 in AUROC (0.72 vs 0.66) and Youden index (0.43 vs 0.32).

What still prevents it from becoming the single preoperative standard

• The main limitation is selection bias (sleep clinic sample). The article itself emphasizes that validation in surgical populations is still needed before adopting it as the sole preoperative standard.

Why does OSA matter so much perioperatively?#

Obstructive sleep apnea (OSA) has long ceased to be an exclusive sleep medicine problem. Perioperatively, it's an important risk factor: it increases the chance of desaturation, airway obstruction, and adverse respiratory and cardiovascular events, especially when the severe form goes unrecognized.

And this is common. In surgical populations, prevalence estimates range from 24% to 41%, reaching 70% in patients undergoing bariatric surgery.

The dilemma: the gold standard doesn't fit routine screening#

The diagnostic gold standard (polysomnography) is unfeasible for routine preoperative screening. That's why questionnaires like STOP-BANG have become widely used.

But the limitations are well known:

• dependence on subjective items, such as snoring and daytime sleepiness/fatigue;
• difficulty understanding the "real weight" of each variable for predicting severity.

This is where the article published in the journal Anaesthesia in December 2025 comes in: "Validation and diagnostic performance of the novel B-APNEIC score for predicting severe obstructive sleep apnoea: a cross-sectional study in an Australian population."

What is the function of the B-APNEIC score?#

The B-APNEIC proposal is to "fragment and simplify" STOP-BANG into 4 items (with asymmetric scoring, emphasizing neck circumference).

Interpretation: a score ≥ 3 suggests higher probability of severe OSA.

The motivation is clear: reduce dependence on self-reported snoring and fatigue and make screening more reproducible in the real world.

Study design#

Key findings#

B-APNEIC performance for severe OSA

In the sample, severe OSA prevalence was 38%. With B-APNEIC ≥ 3, the study found:

• Sensitivity 84% (95%CI 75-90)
• Specificity ~60% (95%CI 52-67)
• PPV 56% (95%CI 48-64)
• NPV 86% (95%CI 78-91)

Direct interpretation for the perioperative setting: when B-APNEIC is < 3, the probability of severe OSA drops substantially (high NPV). The article itself emphasizes this utility "to rule out severe OSA" and warns that positive results require caution due to possible false positives (moderate specificity).

Comparison with STOP-BANG (cutoff ≥ 5)

B-APNEIC showed better overall performance than STOP-BANG for severe OSA:

In other words: B-APNEIC tends to be a better filter to rule out severe OSA and determine who should be referred for polysomnography testing.

Robustness and limitations#

Strengths

• Sample sized by precision estimate (not just convenience).
• Reference with polysomnography and severity definition by AHI (widely accepted standard).
• Blinding between index test and gold standard.
• Complete diagnostic metrics (sensitivity, specificity, predictive values, Youden, AUROC).

Limitations relevant to anesthesiology

• The sample comes from referrals with suspected OSA to the sleep clinic, with risk of selection bias and limited generalization to preoperative clinic screening.
• The study emphasizes that validation in surgical populations is still needed before "safely implementing" as a perioperative screening standard.
• The score was focused on severe OSA (doesn't assess performance for mild/moderate), with explicit rationale that the most consistent association with postoperative complications is with severe OSA.

Conclusions#

The B-APNEIC Score may become a STOP-BANG replacement as an objective screening tool for severe OSA

• If B-APNEIC < 3: the study suggests good performance to rule out severe OSA (NPV 86%).
• If B-APNEIC ≥ 3: treat as high risk for severe OSA, but not as a diagnosis. Polysomnography (gold standard) is needed to confirm the diagnosis.

Translate "high risk for severe OSA" into concrete perioperative decisions

As the article itself emphasizes the link between unrecognized severe OSA and perioperative cardiopulmonary complications, the practical implication is to stratify risk and modulate management, for example:

• airway planning and sedation/anesthesia strategy (avoid "surprises" from airway collapse);
• multimodal analgesia to reduce opioid exposure when possible;
• more conservative criteria for PACU discharge and greater vigilance in patients with suspected severe OSA (especially if hypoxemia, comorbidities, and higher-risk surgery);
• careful patient selection for ambulatory surgery.

Since B-APNEIC focuses on 4 items, screening can be faster

The B-APNEIC advantage is being more objective; so worth standardizing:

• measure neck circumference routinely (it's worth 2 points and is central to the score);
• correct BP measurement;
• calculated BMI;
• directed question about observed apneas.

Final messages (take-home)#

• OSA is common perioperatively and underreporting is high; pragmatic screening remains a necessity.
• B-APNEIC ≥ 3 showed high sensitivity and high NPV for severe OSA and outperformed STOP-BANG ≥ 5 in AUROC/Youden index in this validation.
• Before becoming the sole preoperative standard, the article itself emphasizes the need for validation in surgical populations (such as bariatric surgery candidates and airway surgeries). Therefore, STOP-BANG remains an option for preoperative screening.

A practical way not to let this topic become "another PDF"#

If you use the preoperative as a moment of organized decision-making (not improvisation), it's worth having a workflow to review evidence and standardize screening. In AnestCopilot, Deep Evidence helps search and summarize articles like this in language applied to the perioperative setting, and the rest of the ecosystem comes in as support for day-to-day decisions (without replacing clinical judgment).

Related reading#

• Perioperative Management of GLP-1 and GIP Receptor Agonists
• Etomidate vs Ketamine for RSI in Critical Patients
• Remote Ischemic Preconditioning (RIPC): What the PRINCE Trial Revealed