Diagnostic accuracy of the Berlin questionnaire in detecting obstructive sleep apnea in patients with resistant hypertension

Margallo, Victor; Muxfeldt, Elizabeth Silaid; Guimarães, Gleison M.; Salles, Gil F.

doi:10.1097/hjh.0000000000000297

Cited by 32 publications

(20 citation statements)

References 31 publications

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“…33 Our review identified nineteen studies that evaluated the performance of the Berlin Questionnaire against PSG in the identification of patients with OSA. [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] The studies were conducted in a wide variety of geographic locations including Brazil, 38 Canada, 34,42 Greece, 37 Iran, 36 Korea, 40 Turkey, 43 and the United States. 41,44 Various patient populations were considered, including those in primary care clinics, sleep clinics, the veteran population, and patients with cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Kapur

Auckley

Chowdhuri

et al. 2017

Journal of Clinical Sleep Medicine

1,899

1,498

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Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. Recommendations:The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements:Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation. Recommendations:1. We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG) 2. We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG) 3. We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG) 4. We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG) 5. We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protoc...

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Section: Discussionmentioning

confidence: 99%

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Kapur

Auckley

Chowdhuri

et al. 2017

Journal of Clinical Sleep Medicine

1,899

1,498

View full text Add to dashboard Cite

show abstract

“…All participants gave a written informed consent and the local Ethics Committee had previously approved the study protocol. The study began as an observational cohort 14,21 to establish OSA prevalence from September 2010 to December 2011; and the RCT began in January 2012, after trial registration, and ended in July 2014. An Expanded Methods section is available in the onlineonly Data Supplement, where the eligibility criteria, polysomnographic and BP measurement methods, the randomization procedure and patients' follow-up are detailed.…”

Section: Design Overviewmentioning

confidence: 99%

“…19 A recent meta-analysis 20 of the first 3 studies still suggested only modest ambulatory BP reductions of 1.8 to 3.9 mm Hg on systolic blood pressure (SBP) and 2.5 to 3.5 mm Hg on diastolic blood pressure (DBP). Therefore, we took advantage of an existing cohort of resistant hypertensive patients, 12,14,21 and designed a parallel-group RCT to assess the effects of a 6-month CPAP treatment on clinic and ambulatory BP levels in mostly asymptomatic moderate/severe OSA patients with resistant hypertension.…”

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confidence: 99%

Effects of Continuous Positive Airway Pressure Treatment on Clinic and Ambulatory Blood Pressures in Patients With Obstructive Sleep Apnea and Resistant Hypertension

et al. 2015

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Abstract-The effect of continuous positive airway pressure (CPAP) on blood pressures (BPs) in patients with resistant hypertension and obstructive sleep apnea is not established. We aimed to evaluate it in a randomized controlled clinical trial, with blinded assessment of outcomes. Four hundred thirty-four resistant hypertensive patients were screened and 117 patients with moderate/severe obstructive sleep apnea, defined by an apnea-hypopnea index ≥15 per hour, were randomized to 6-month CPAP treatment (57 patients) or no therapy (60 patients), while maintaining antihypertensive treatment. Clinic and 24-hour ambulatory BPs were obtained before and after 6-month treatment. Primary outcomes were changes in clinic and ambulatory BPs and in nocturnal BP fall patterns. Intention-to-treat and per-protocol (limited to those with uncontrolled ambulatory BPs) analyses were performed. Patients had mean (SD) 24-hour BP of 129 (16)

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“…Although mitochondrial DNA mutation appears promising in screening OSA in male patients, the findings require further verification (17). The Berlin questionnaire is also used widely for diagnosis; however, the actual association between the results of the Berlin questionnaire and OSA, is still debated (18). Similarly, the STOPBang questionnaire was recently revealed to have low accuracy, with sensitivities of 81–86% and specificities of 34–57% using cut-off values of the PSG respiratory disturbance index of 5, 15 and 30 events/h (19,22).…”

Section: Discussionmentioning

confidence: 99%

Validation of a novel sleep-monitoring system for diagnosing obstructive sleep apnea: A comparison with polysomnography

Meng

Guan

et al. 2016

Experimental and Therapeutic Medicine

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Overnight polysomnography (PSG) is currently the gold standard for diagnosing obstructive sleep apnea (OSA); however, it is time-consuming, expensive and uncomfortable for the patient. A micromovement sensitive mattress (MSM) sleep-monitoring system was developed as an alternative to PSG, however, there has yet to be a study verifying the accuracy of diagnosing OSA with this device. Therefore, the present study assessed the validity of the MSM sleep-monitoring system. Chinese Han participants who were suspected of having OSA were recruited between June 2013 and June 2014. The MSM sleep-monitoring system and PSG were utilized simultaneously overnight on each subject. The apnea-hypopnea index (AHI) was measured by the MSM sleep-monitoring system (AHIMSM) and compared with that determined by PSG (AHIPSG), revealing a significant correlation between the two values (r=0.97, P<0.001). Bland-Altman plots also indicated good agreement (97%) between MSM and PSG. Using an AHIPSG cut-off of ≥5, ≥15 and ≥30 events/h, the sensitivity (specificity) of detecting an AHIMSM of ≥5, ≥15, and ≥30 events/h were 94.9 (100%), 89.9 (96.9%) and 90.3% (94.9%), respectively. The areas under the receiver operating characteristic curve, which were used to differentiate an AHIPSG of ≥5, ≥15 and ≥30 events/h in clinically diagnosed OSA, were 0.984, 0.982 and 0.980, respectively. Thus, the MSM sleeping system may accurately diagnose OSA in the Chinese Han population. Further community-based studies with larger sample sizes are warranted to confirm the validity of this MSM sleeping system.

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Diagnostic accuracy of the Berlin questionnaire in detecting obstructive sleep apnea in patients with resistant hypertension

Abstract: In a large cohort of resistant hypertensive patients, the Berlin questionnaire had a low accuracy of identifying patients with OSA and should not be used as a screening method for selecting patients to PSG.

Cited by 32 publications

References 31 publications

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Effects of Continuous Positive Airway Pressure Treatment on Clinic and Ambulatory Blood Pressures in Patients With Obstructive Sleep Apnea and Resistant Hypertension

Validation of a novel sleep-monitoring system for diagnosing obstructive sleep apnea: A comparison with polysomnography

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