Is the Berlin questionnaire a useful tool to diagnose sleep apnea in the elderly?
ABSTRACT In the elderly, obstructive sleep apnea (OSA) is frequently under diagnosed. This study was undertaken to assess the accuracy of the Berlin questionnaire to diagnose OSA in a large healthy elderly population.
Six hundred forty-three participants aged 65.6 years were examined. All subjects completed the Berlin questionnaire and underwent at-home respiratory recording. Presence of OSA was defined by an AHI>15.
Of the respondents, 202 subjects (31.4%) were in an OSA high-risk group according to the Berlin questionnaire. The high-risk subjects were significantly heavier, had greater waist and hip circumferences, higher AHI, and reported more frequently hypertension and diabetes. Habitual snoring was present in 54% of the sample, sleepiness in 12% of participants, and a BMI>30 and a history of hypertension in 42.1%. Being in the high-risk group predicted an AHI>15 with a sensitivity of 77%, a specificity of 39%, a positive predictive value of 63% and a negative predictive value of 55%. Among Berlin questionnaire categories, snoring correctly classified 61% of the sample and explained the 5% variance of AHI.
The Berlin questionnaire did not provide a high level of diagnostic specificity to discriminate OSA in an elderly population. Although not sufficiently accurate, this questionnaire can be used to identify subjects for sleep study assessment.
- SourceAvailable from: Sanjeev Nair
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- "Even though we employed strict parameters for diagnosing new-onset AF, asymptomatic cases of paroxysmal AF could have been missed and the incidence of AF may even be underestimated due to the short follow-up period of two years. Despite strict inclusion criteria, it is still possible that we could have underestimated the number of OSA patients since OSA is frequently under-diagnosed in the elderly population. Our study findings are also limited by the fact that subjects in non-OSA group were not evaluated with a sleep study. "
ABSTRACT: Co-existence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is referred to as overlap syndrome. Overlap patients have greater degree of hypoxia and pulmonary hypertension than patients with OSA or COPD alone. Studies showed that elderly patients with OSA alone do not have increased risk of atrial fibrillation (AF) but it is not known if overlap patients have higher risk of AF. To determine whether elderly patients with overlap syndrome have an increased risk of AF. In this single center, community-based retrospective cohort analysis, data were collected on 2,873 patients > 65 years of age without AF, presenting in the year 2006. Patients were divided into OSA group (n = 60), COPD group (n = 416), overlap syndrome group (n = 28) and group with no OSA or COPD (n = 2369). The primary endpoint was incidence of new-onset AF over the following two years. Logistic regression was performed to adjust for heart failure (HF), coronary artery disease, hypertension (HTN), cerebrovascular disease, cardiac valve disorders, diabetes mellitus, hyperlipidemia, chronic kidney disease (CKD) and obesity. The incidence of AF was 10% in COPD group, 6% in OSA group and 21% in overlap syndrome group (P < 0.05). After adjusting for age, sex, HF, CKD, and HTN, patients with overlap syndrome demonstrated a significant association with new-onset AF (OR = 3.66, P = 0.007). HF, CKD and HTN were also significantly associated with new-onset AF (P < 0.05). Among elderly patients, the presence of overlap syndrome is associated with a marked increase in risk of new-onset AF as compared to the presence of OSA or COPD alone.Journal of Geriatric Cardiology 06/2013; 10(2):129-34. DOI:10.3969/j.issn.1671-5411.2013.02.001 · 1.06 Impact Factor
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ABSTRACT: Kardiologische Patienten zeigen eine hohe Prävalenz an schlafbezogenen Atemstörungen (SBAS). Während obstruktive Schlafapnoesyndrome gehäuft bei Patienten mit Vorhofflimmern, Bluthochdruck und kardialen Ischämien vorkommen, leiden Herzinsuffizienzpatienten zu einem signifikanten Anteil an zentralen Schlafapnoesyndromen (CSA). Goldstandard der Diagnostik einer SBAS ist die Polysomnographie (PSG). Viele Patienten mit SBAS werden jedoch aufgrund der nicht flächendeckend verfügbaren, personal- und kostenaufwendigen Diagnostik bislang nicht diagnostiziert. Daher ist die Etablierung von einfachen Screeningverfahren in der kardiologischen Routine wichtig. Einfache Screeningverfahren sind z. B. standardisierte Fragebögen, die gute Ergebnisse bei Kollektiven mit OSA, nicht aber bei Patienten mit CSA gezeigt haben. Darüber hinaus werden tragbare Screeninggeräte, die Oxymetrie und/oder Atemflüsse messen, erfolgreich im ambulanten Screening angewendet. Vielversprechend sind neuere Algorithmen, die aus Herzfrequenzvariabilität und/oder QRS-Morphologie aus Standard-Langzeit-Elektrokardiogrammen (LZ-EKG) Apnoe-Hypopnoe-Indices (AHI) ermitteln können. Die Etablierung von SBAS-Screening mittels LZ-EKG könnte in Zukunft ein umfassendes Screening kardiovaskulärer Patienten sicherstellen.Herzschrittmachertherapie & Elektrophysiologie 03/2012; 23(1). DOI:10.1007/s00399-012-0169-y
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ABSTRACT: Aim Obstructive sleep apnea (OSA) is a common medical condition with significant adverse consequences. OSA awareness among the general population and physicians in Armenia is quite low. This study aimed to estimate the prevalence of OSA symptoms and risk factors in Armenia, which has not been investigated so far. Patients and methods This was a cross-sectional study of 1,500 randomly selected adults from the capital city and regions of the country. The instrument used to assess the risk of OSA was the Berlin questionnaire. Results Of the 1,500 respondents, 44% (49% of men and 37% of women) were identified as being at high risk of OSA. In both genders the risk of OSA increased with age achieving the maximum level of 60% at the age of 50–69 years and declining to 45% after the age of 70 years. Before the age of 50 years, men were at higher risk of OSA than women (42% vs. 19%, p < 0.001). After 50 the risk of having OSA was almost the same in men and women (57% vs. 56%). Conclusion Almost every second Armenian male and every third female citizen could benefit from evaluation for OSA.Somnologie - Schlafforschung und Schlafmedizin 12/2012; 16(4). DOI:10.1007/s11818-012-0588-3