Abstract
The aim of this study was to assess the utility of the Berlin questionnaire (BQ) in adult patients at high risk of obstructive sleep apnea (OSA). The study consisted of 64 patients recruited for the polysomnography diagnostics of sleep respiratory disturbances. The anthropometric assessment included body weight, height, and body mass index (BMI), all related to the risk of OSA. The BQ consisted of the following three categories: 1 – snoring, 2 – daytime somnolence, and 3 – hypertension. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. Likelihood ratio was used to assess the diagnostic accuracy. We found that patients were, on average obese; the mean BMI amounted to 31.9 ± 6.0 kg/m2. Polysomnography identified OSA in 73.4% of patients (AHI >5), where the BQ categorized 87.5% of patients at high risk of OSA. Sensitivity of the BQ was 87.2%, specificity 11.8%, PPV 73.2%, and NPV 25.0%. Diagnostic accuracy assessed by the likelihood ratio had a value of 1.00. The BQ had a false discovery rate of 31.2% and misclassification rate of 32.8%. We conclude that the BQ is a sensitive tool that should be used in clinical settings in which the benefit of high sensitivity outweighs the disadvantage of low specificity.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
AASM (1999) American Academy of Sleep Medicine European Respiratory Society Australasian Sleep Association American Thoracic Society Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research: the report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689
Ahmadi N, Chung SA, Gibbs A, Shapiro CM (2008) The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath 12(1):39–45
Arunsurat I, Luengyosluechakul S, Prateephoungrat K, Siripaupradist P, Khemtong S, Jamcharoensup K, Thanapatkaiporn N, Limpawattana P, Laohasiriwong S, Pinitsoontorn S, Boonjaraspinyo S, Sawanyawisuth K (2016) Simplified Berlin questionnaire for screening of high risk for obstructive sleep apnea among Thai male healthcare workers. J UOEH 38(3):199–206
Boulos MI, Wan A, Im J, Elias S, Frankul F, Atalla M, Black SE, Basile VS, Sundaram A, Hopyan JJ, Boyle K, Gladstone DJ, Murray BJ, Swartz RH (2016) Identifying obstructive sleep apnea after stroke/TIA: evaluating four simple screening tools. Sleep Med 21:133–139
Cole TJ (1990) The LMS method for constructing normalized growth standards. Eur J Clin Nutr 44:45–60
Cowan DC, Allardice G, Macfarlane D, Ramsay D, Ambler H, Banham S, Livingston E, Carlin C (2014) Predicting sleep disordered breathing in outpatients with suspected OSA. BMJ 4(4):e004519
Desalu O, Onyedum C, Sanya E, Fadare J, Adeoti A, Salawu F, Oluyombo R, Olamoyegun M, Fawale M, Gbadegesin B, Bello H (2016) Prevalence, awareness and reporting of symptoms of obstructive sleep apnoea among hospitalized adult patients in Nigeria: a multicenter study. Ethiop J Health Sci 26(4):321–330
Dimitrov L, Macavei V (2016) Can screening tools for obstructive sleep apnea predict postoperative complications? A systematic review of the literature. J Clin Sleep Med 12(9):1293–1300
Enciso R, Clark GT (2011) Comparing the Berlin and the ARES questionnaire to identify patients with obstructive sleep apnea in a dental setting. Sleep Breath 15(1):83–89
Foster GD, Borradaile KE, Sanders MH, Millman R, Zammit G, Newman AB, Wadden TA, Kelley D, Wing RR, Pi-Sunyer FX, Reboussin D, Kuna ST, Sleep AHEAD Research Group of Look AHEAD Research Group (2009) A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med 169(17):1619–1626
Gupta R, Ali R, Dhyani M, Das S, Pundir A (2016) Hindi translation of Berlin questionnaire and its validation as a screening instrument for obstructive sleep apnea. J Neurosci Rural Pract 7(2):244–249
Gokay P, Tastan S, Orhan ME (2016) Is there a difference between the STOP-BANG and the Berlin obstructive sleep apnoea syndrome questionnaires for determining respiratory complications during the perioperative period? J Clin Nurs 25(9–10):1238–1252
Iber C, Ancoli-Israel S, Chesson A, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester
Khaledi-Paveh B, Khazaie H, Nasouri M, Ghadami MR, Tahmasian M (2016) Evaluation of Berlin questionnaire validity for sleep apnea risk in sleep clinic populations. Basic Clin Neurosci 7(1):43–48
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M et al (2014) Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and the European Society of Cardiology. 2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension. Blood Press 23(1):3–16
Margallo VS, Muxfeldt ES, Guimarães GM, Salles GF (2014) Diagnostic accuracy of the Berlin questionnaire in detecting obstructive sleep apnea in patients with resistant hypertension. J Hypertens 32(10):2030–2036
Miller JN, Berger AM (2016) Screening and assessment for obstructive sleep apnea in primary care. Sleep Med Rev 29:41–51
Netzer NC, Stoohs SA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491
Oku Y, Okada M (2008) Periodic breathing and dysphagia associated with a localized lateral medullary infarction. Respirology 13(4):608–610
Sert Kuniyoshi FH, Zellmer MR, Calvin AD, Lopez-Jimenez F, Albuquerque FN, van der Walt C, Trombetta IC, Caples SM, Shamsuzzaman AS, Bukartyk J, Konecny T, Gami AS, Kara T, Somers VK (2011) Diagnostic accuracy of the Berlin questionnaire in detecting sleep-disordered breathing in patients with a recent myocardial infarction. Chest 140(5):1192–1197
Silva KV, Rosa ML, Jorge AJ, Leite AR, Correia DM, Silva Dde S, Cetto DB, Brum Ada P, Silveira Netto P, Rodrigues GD (2016) Prevalence of risk for obstructive sleep apnea syndrome and association with risk factors in primary care. Arq Bras Cardiol 106(6):474–480
Thurtell MJ, Bruce BB, Rye DB, Newman NJ, Biousse V (2011) The Berlin questionnaire screens for obstructive sleep apnea in idiopathic intracranial hypertension. J Neuroophthalmol 31(4):316–319
Westlake K, Plihalova A, Pretl M, Lattova Z, Polak J (2016) Screening for obstructive sleep apnea syndrome in patients with type 2 diabetes mellitus: a prospective study on sensitivity of Berlin and STOP-Bang questionnaires. Sleep Med. doi:10.1016/j.sleep.2016.07.009
Acknowledgements
The authors are grateful to Dr. Robert Tower for proofreading of the manuscript.
Conflicts of Interest
The authors declare no conflicts of interest in relation to this article.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Stelmach-Mardas, M., Iqbal, K., Mardas, M., Kostrzewska, M., Piorunek, T. (2017). Clinical Utility of Berlin Questionnaire in Comparison to Polysomnography in Patients with Obstructive Sleep Apnea. In: Pokorski, M. (eds) Respiratory System Diseases. Advances in Experimental Medicine and Biology(), vol 980. Springer, Cham. https://doi.org/10.1007/5584_2017_7
Download citation
DOI: https://doi.org/10.1007/5584_2017_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-59497-2
Online ISBN: 978-3-319-59498-9
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)