The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance

Abstract

The Berlin questionnaire (BQ) has been used to help identify patients at high risk of having sleep apnea in primary care and atrial fibrillation patients. The BQ may be a useful adjunct in sleep medicine and research, but it has never been validated in a sleep clinic population. The aim of the study is to determine the specificity and sensitivity of the BQ compared to the respiratory disturbance index (RDI) values obtained from two nights of polysomnographic recording in a sleep clinic population. This is a retrospective chart review study of 130 sleep clinic patients. Patients' demographics, BQ scores, RDI measurements, and sleep study parameters were extracted from the patients' chart. Of the 130 charts reviewed, the BQ identified 76 (58.5%) as being at high-risk of having sleep apnea, but overnight polysomnography found only 34 of the 130 patients (26.2%) had an RDI > 10. The BQ performed with 0.62 sensitivity and 0.43 specificity at the RDI > 10 level. Due to the low sensitivity and specificity as well as the large number of false negatives and positives, the Berlin questionnaire is not an appropriate instrument for identifying patients with sleep apnea in a sleep clinic population.

A systematic review of screening questionnaires for obstructive sleep apnea

“…Chung 2008 studies clearly specified all of the above criteria, and Ahmadi 2008, a retrospective study, adequately addressed items two and three, but not the first item (blind execution of PSG). 30 Overall, the studies by Chung et al on the STOP and STOP-Bang questionnaires had the highest internal validity. 31,32 In terms of the external validity (generalizability), most of the studies met the appraisal items adequately (Table 5).…”

“…In an effort to unify the subject populations, all studies were divided into two major groups: studies on patients ''with sleep disorder problems'' 25,27,30,35 and studies on ''patients without known sleep problems''. 28,29,[31][32][33][34] Due to the high prevalence of OSA in patients with sleep disorders, we could not use the first group of studies as a reference for the strength of the questionnaires designed to screen OSA in the general population.…”

“…28 Only three studies adequately addressed the validation process of the questionnaires (Chung 2008a, Chung 2008b, and Ahmadi 2008). [30][31][32] The other included studies did not have specific information to clearly evaluate the risk of bias during the validation process of their questionnaires. More specifically, the following aspects were not specified in the papers: 1) blind execution of the PSG and questionnaire, i.e., those who performed the PSG were unaware of the results of the questionnaire (and vice versa); 2) avoidance of verification bias, i.e., interpretation of the PSG results was performed independent of the questionnaire results; and 3) interpretation of the PSG results was performed independent from the patient's clinical history.…”

“…The total of the excluded studies is not the overall sum, because one study was excluded due to an irrelevant outcome and a questionnaire that was not written in English Screening questionnaires for obstructive sleep apnea 425 33,34 and one in Europe. 35 Nine studies were prospective cohort, while one study 30 was a retrospective chart review of patients who had already undergone PSG in a sleep laboratory ( Table 1). …”

Sleep‐disordered breathing in heart failure: facts and numbers

“…Even screening tools that work well in subjects without HF such as the Epworth Sleepiness Scale have not proven reliable in patients with HF 38. Other screening questionnaires are the Berlin Questionnaire39, 40 and the STOP‐Bang Sleep Apnea Questionnaire,41, 42, 43, 44 but both have not been validated in patients with HF. The severity of the disease can be screened for using two indices: The Apnoe–Hypopnoe Index (AHI) and Oxygen Desaturation Index (ODI).…”