Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP: Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome

Center for Sleep Education and Research, Case Western Reserve University, Cleveland, Ohio, USA.
Annals of internal medicine (Impact Factor: 17.81). 11/1999; 131(7):485-91. DOI: 10.7326/0003-4819-131-7-199910050-00041
Source: PubMed


Although sleep apnea is common, it often goes undiagnosed in primary care encounters.
To test the Berlin Questionnaire as a means of identifying patients with sleep apnea.
Survey followed by portable, unattended sleep studies in a subset of patients.
Five primary care sites in Cleveland, Ohio.
744 adults (of 1008 surveyed [74%]), of whom 100 underwent sleep studies.
Survey items addressed the presence and frequency of snoring behavior, waketime sleepiness or fatigue, and history of obesity or hypertension. Patients with persistent and frequent symptoms in any two of these three domains were considered to be at high risk for sleep apnea. Portable sleep monitoring was conducted to measure the number of respiratory events per hour in bed (respiratory disturbance index [RDI]).
Questions about symptoms demonstrated internal consistency (Cronbach correlations, 0.86 to 0.92). Of the 744 respondents, 279 (37.5%) were in a high-risk group that was defined a priori. For the 100 patients who underwent sleep studies, risk grouping was useful in prediction of the RDI. For example, being in the high-risk group predicted an RDI greater than 5 with a sensitivity of 0.86, a specificity of 0.77, a positive predictive value of 0.89, and a likelihood ratio of 3.79.
The Berlin Questionnaire provides a means of identifying patients who are likely to have sleep apnea.

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    • "BQ is a simple and useful tool for screening OSA risk in the general population. Netzer and colleagues assessed efficacy of BQ in the primary care setting on 744 subjects with portable sleep monitoring (Netzer et al., 1999). BQ has 3 sections. "

    Basic and Clinical Neuroscience 01/2016; 7(1).
    • "Participants reported whether they had a diagnosis of obstructive sleep apnea (OSA). Those without a previous diagnosis were interviewed using the Berlin questionnaire to assess the risk of OSA, which categorizes respondents as high or low risk of having OSA (Netzer et al., 1999). The questionnaire was previously validated in a Thai population (Suksakorn et al., 2014). "
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    ABSTRACT: There is evidence that the sleep and circadian systems play a role in glucose metabolism. In addition to physiological factors, sleep is also affected by behavioral, environmental, cultural and social factors. In this study, we examined whether morning or evening preference, sleep timing and sleep duration are associated with glycemic control in patients with type 2 diabetes residing in Thailand. Two hundred and ten type 2 diabetes patients who were not shift workers completed an interview and questionnaires to collect information on diabetes history, habitual sleep duration and sleep timing. Chronotype, an individual's tendency for being a "morning" or "evening" person, was assessed using the Composite Score of Morningness (CSM), which reflects an individual's subjective preference for activities in the morning or evening, as well as mid-sleep time on weekend nights (MSF), which reflects their actual sleep behavior. Most recent hemoglobin A1c (HbA1c) values were retrieved from medical records. Evening preference (as indicated by lower CSM), later bedtime on weekends, and shorter sleep duration correlated with higher HbA1c (r = -0.18, p = 0.01; r = 0.17, p = 0.01 and r = -0.17, p = 0.01, respectively), while there was no association between MSF or wake up time and glycemic control. In addition, later bedtime on weekends significantly correlated with shorter sleep duration (r = -0.34, p < 0.001). Hierarchical regression analyses adjusting for age, sex, body mass index, insulin use and diabetes duration revealed that later bedtime on weekends was significantly associated with poorer glycemic control (B = 0.018, p = 0.02), while CSM was not. Mediation analysis revealed that this association was fully mediated by sleep duration. In summary, later bedtime on weekends was associated with shorter sleep duration and poorer glycemic control in patients with type 2 diabetes. It is likely that patients with later weekend bedtimes curtail their sleep by waking up earlier. Exploring the potential reasons for this phenomenon (e.g. cultural influences, metropolitan lifestyle, environmental factors, family and social obligations) specific to a Thai population may help identify behavioral modifications (i.e. earlier bedtime and/or sleep duration extension) that could possibly lead to improved glycemic control in this population.
    Chronobiology International 11/2015; DOI:10.3109/07420528.2015.1105812 · 3.34 Impact Factor
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    • "During the first follow-up of the cohort, five years after baseline, the responded individuals underwent a new physical (n = 5064) and psychiatric (n = 4002) examination, and were given questionnaires by trained interviewers, which included questions on demographic, medical, and treatment history as well as smoking and alcohol consumption . Sleep-related complaints and habits were investigated using the Pittsburgh Sleep Quality Index [11], the Epworth Sleepiness Scale [12], and the Berlin Questionnaire for sleep-disordered breathing [13]. The CoLaus/PsyCoLaus and HypnoLaus studies were approved by the Ethics Committee of the University of Lausanne, and a written informed consent was obtained from all participants at the baseline and for the follow-up assessments. "
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    ABSTRACT: Introduction: The aim of this study was to evaluate if there is a significant effect of lunar phases on subjective and objective sleep variables in the general population. Methods: A total of 2125 individuals (51.2% women, age 58.8 ± 11.2 years) participating in a population-based cohort study underwent a complete polysomnography (PSG) at home. Subjective sleep quality was evaluated by a self-rating scale. Sleep electroencephalography (EEG) spectral analysis was performed in 759 participants without significant sleep disorders. Salivary cortisol levels were assessed at awakening, 30 min after awakening, at 11 am, and at 8 pm. Lunar phases were grouped into full moon (FM), waxing/waning moon (WM), and new moon (NM). Results: Overall, there was no significant difference between lunar phases with regard to subjective sleep quality. We found only a nonsignificant (p = 0.08) trend toward a better sleep quality during the NM phase. Objective sleep duration was not different between phases (FM: 398 ± 3 min, WM: 402 ± 3 min, NM: 403 ± 3 min; p = 0.31). No difference was found with regard to other PSG-derived parameters, EEG spectral analysis, or in diurnal cortisol levels. When considering only subjects with apnea/hypopnea index of <15/h and periodic leg movements index of <15/h, we found a trend toward shorter total sleep time during FM (FM: 402 ± 4, WM: 407 ± 4, NM: 415 ± 4 min; p = 0.06) and shorter-stage N2 duration (FM: 178 ± 3, WM: 182 ± 3, NM: 188 ± 3 min; p = 0.05). Conclusion: Our large population-based study provides no evidence of a significant effect of lunar phases on human sleep.
    Sleep Medicine 10/2015; 16(11):1321-1326. DOI:10.1016/j.sleep.2015.08.002 · 3.15 Impact Factor
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