Frontiers of Medicine

, Volume 12, Issue 2, pp 189–195 | Cite as

Identification of surgical patients at high risk of OSAS using the Berlin Questionnaire to detect potential high risk of adverse respiratory events in post anesthesia care unit

  • Fei Liu
  • Li Liu
  • Fang Zheng
  • Xiangdong Tang
  • Yongxin Bao
  • Yunxia Zuo
Research Article


Obstructive sleep apnea syndrome (OSAS) increases the risk of post-surgery complications. This study uses Berlin Questionnaire (BQ) to identify Chinese adult surgical patients who are at a high risk of OSAS and to determine if the BQ could be used to detect potential high risk of adverse respiratory events in the post anesthesia care unit (PACU). Results indicated that only 11.4% of the patients were considered at a high risk of OSAS. Age and body mass index are the key factors for the risk of OSAS prevalence in China and also gender specific. Furthermore, the incidence of adverse respiratory events in the PACU was higher in patients with high risk of OSAS than others (6.8% vs. 0.9%, P < 0.001). They also stayed longer than others in the PACU (95 ± 28 min vs. 62 ± 19 min, P < 0.001). Age, high risk for OSAS, and smoking were independent risk factors for the occurrence of adverse respiratory events in the PACU. The BQ may be adopted as a screening tool for anesthesiologists in China to identify patients who are at high risk of OSAS and determine the potential risk of developing postoperative respiratory complications in the PACU.


obstructive sleep apnea Berlin Questionnaire Chinese surgical patients adverse respiratory event 


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This study was funded by the National Natural Science Foundation of China (No. NSF30870891/C090302).


  1. 1.
    Ferini-Strambi L, Fantini ML, Castronovo C. Epidemiology of obstructive sleep apnea syndrome. Minerva Med 2004; 95(3): 187–202PubMedGoogle Scholar
  2. 2.
    Valipour A. Gender-related differences in the obstructive sleep apnea syndrome. Pneumologie 2012; 66(10): 584–588CrossRefPubMedGoogle Scholar
  3. 3.
    Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, Bottros M, Selvidge JA, Jacobsohn E, Pulley D, Duntley S, Becker C, Avidan MS. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 2009; 10(7): 753–758CrossRefPubMedGoogle Scholar
  4. 4.
    Mannarino MR, Di Filippo F, Pirro M. Obstructive sleep apnea syndrome. Eur J Intern Med 2012; 23(7): 586–593CrossRefPubMedGoogle Scholar
  5. 5.
    Zamarron C, García Paz V, Riveiro A. Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Intern Med 2008; 19(6): 390–398CrossRefPubMedGoogle Scholar
  6. 6.
    Chung F, Mokhlesi B. Postoperative complications associated with obstructive sleep apnea: time to wake up! Anesth Analg 2014; 118(2): 251–253Google Scholar
  7. 7.
    Mador MJ, Goplani S, Gottumukkala VA, El-Solh AA, Akashdeep K, Khadka G, Abo-Khamis M. Postoperative complications in obstructive sleep apnea. Sleep Breath 2013; 17(2): 727–734CrossRefPubMedGoogle Scholar
  8. 8.
    Chung F. Screening for obstructive sleep apnea syndrome in the preoperative patients. Open Anesthesiol J 2011; 5 (1): A255–A256CrossRefGoogle Scholar
  9. 9.
    Ahmadi N, Shapiro GK, Chung SA, Shapiro CM. Clinical diagnosis of sleep apnea based on single night of polysomnography vs. two nights of polysomnography. Sleep Breath 2009; 13(3): 221–226CrossRefPubMedGoogle Scholar
  10. 10.
    Knotherus A, Buntinx F. The Evidence Base of Clinical Diagnosis: Theory and Methods of Diagnostic Research. West Sussex: Wiley-Balckwell, BMJ Books, 2009Google Scholar
  11. 11.
    von Känel R, Malan NT, Hamer M, Lambert GW, Schlaich M, Reimann M, Malan L. Three-year changes of prothrombotic factors in a cohort of South Africans with a high clinical suspicion of obstructive sleep apnea. Thromb Haemost 2016; 115(1): 63–72CrossRefGoogle Scholar
  12. 12.
    Amra B, Saberpur S, Ghoharian V, Tabatabai SA, Akbari M, Beni BH. Berlin questionnaire study in surgical patient in Alzahra hospital in year 2010. Adv Biomed Res 2013; 2: 16CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Bouloukaki I, Komninos ID, Mermigkis C, Micheli K, Komninou M, Moniaki V, Mauroudi E, Siafakas NM, Schiza SE. Translation and validation of Berlin questionnaire in primary health care in Greece. BMC Pulm Med 2013; 13(1): 6–10CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Kang K, Park KS, Kim JE, Kim SW, Kim YT, Kim JS, Lee HW. Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study. Sleep Breath 2013; 17(2): 803–810CrossRefPubMedGoogle Scholar
  15. 15.
    L XP, Zhang C, Ma J, Su L, Jia P, Luo YP, Wei SM, Wang GF. Application of Berlin questionnaire in the screening of obstructive sleep apnea hypopnea syndrome. Chin J Tuberc Respir Dis (Zhonghua Jie He He Hu Xi Za Zhi) 2011; 34(7): 515–519 (in Chinese)Google Scholar
  16. 16.
    Taj F, Aly Z, Arif O, Khealani B, Ahmed M. Risk for sleep apnea syndrome in Pakistan: a cross-sectional survey utilizing the Berlin questionnaire. Sleep Breath 2009; 13(1): 103–106CrossRefPubMedGoogle Scholar
  17. 17.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131(7): 485–491CrossRefPubMedGoogle Scholar
  18. 18.
    Liu J, Wei C, Huang L, Wang W, Liang D, Lei Z, Wang F, Wang X, Hou X, Tang X. Prevalence of signs and symptoms suggestive of obstructive sleep apnea syndrome in Guangxi, China. Sleep Breath 2014; 18(2): 375–382CrossRefPubMedGoogle Scholar
  19. 19.
    Lockhart EM, Willingham MD, Abdallah AB, Helsten DL, Bedair BA, Thomas J, Duntley S, Avidan MS. Obstructive sleep apnea screening and postoperative mortality in a large surgical cohort. Sleep Med 2013; 14(5): 407–415CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Chung F, Ward B, Ho J, Yuan H, Kayumov L, Shapiro C. Preoperative identification of sleep apnea risk in elective surgical patients, using the Berlin questionnaire. J Clin Anesth 2007; 19(2): 130–134CrossRefPubMedGoogle Scholar
  21. 21.
    Agrawal S, Gupta R, Lahan V, Mustafa G, Kaur U. Prevalence of obstructive sleep apnea in surgical patients presenting to a tertiary care teaching hospital in India: a preliminary study. Saudi J Anaesth 2013; 7(2): 155–159CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, Kales A. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001; 163(3): 608–613CrossRefPubMedGoogle Scholar
  23. 23.
    Zhou XH, Wang HJ, Wang KF. Menopausal age of intellectual women: an investigation of 2694 cases. Anhui Med Pharm J (Anhui Yi Yao) 2012; 2: 27–29 (in Chinese)Google Scholar
  24. 24.
    Sanner B, Haske M, Buchner N, Zidek W. Hypertension and sleeprelated breathing disorders. Nieren-Und Hochdrckkrankheiten 2000; 29: 321–325Google Scholar
  25. 25.
    Malow BA, Levy K, Maturen K, Bowes R. Obstructive sleep apnea is common in medically refractory epilepsy patients. Neurology 2000; 55(7): 1002–1007CrossRefPubMedGoogle Scholar
  26. 26.
    Pollak L, Shpirer I, Rabey JM, Klein C, Schiffer J. Polysomnography in patients with intracranial tumors before and after operation. Acta Neurol Scand 2004; 109(1): 56–60CrossRefPubMedGoogle Scholar
  27. 27.
    Gaddam S, Gunukula SK, Mador MJ. Post-operative outcomes in adult obstructive sleep apnea patients undergoing non-upper airway surgery: a systematic review and meta-analysis. Sleep Breath 2014; 18(3): 615–633CrossRefPubMedGoogle Scholar

Copyright information

© Higher Education Press and Springer-Verlag GmbH Germany 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology, West China HospitalSichuan UniversityChengduChina
  2. 2.School of ComputingChongqing UniversityChongqingChina
  3. 3.School of Information Science & EngineeringLanzhou UniversityLanzhouChina
  4. 4.Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China HospitalSichuan UniversityChengduChina
  5. 5.Qingdao Women’s and Children’s HospitalQingdaoChina

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