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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    • "This addressed risk factors for sleep apnea adapted from the Berlin Questionnaire (Netzer, Stoohs, Netzer, Clark, & Strohl, 1999), including snoring history, tiredness, and history of high blood pressure or obesity (Mustafa, Erokwu, Ebose, & Strohl, 2005). One point was awarded for each of the following items: (1) self-reported snoring ≥3 times a week; (2) self-reported falling asleep during quiet activities ≥3 times a week; and (3) either hypertension (self-reported physician diagnosis or measured systolic blood pressure[ "
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    ABSTRACT: Purpose of the Study: To compare the prevalence and cardiometabolic health impact of sleep disturbance among postmenopausal Veteran and non-Veteran participants in the Women’s Health Initiative (WHI).
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    • "We employed the Berlin Questionnaire to screen for OSAHS (Netzer et al. 1999), which has been translated and shown to be a sensitive and predictive screening tool for OSAHS in primary healthcare settings in Greece (Bouloukaki et al. 2013). In brief, the questionnaire evaluates snoring behaviour and witnessed apnoeas during sleep ( " Background " section), tiredness or fatigue after sleep ( " Methods " section) and history of hypertension and obesity ( " Results " section). "
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    ABSTRACT: Obstructive sleep apnoea–hypopnea syndrome (OSAHS) and multimorbidity are common in elderly patients, but a potential link between the two conditions remains unclear. This study aimed to assess the prevalence of OSAHS, chronic multimorbidity and their relation in older adults in primary care settings. A screening study was performed in a cross-section of 490 elderly adults (mean age 77.5 years, 51 % male) receiving home care services in Thessaly, central Greece. The Berlin Questionnaire was employed to assess the likelihood for OSAHS and the Epworth Sleepiness Scale to assess daytime sleepiness. Multimorbidity was defined as a documented history of at least two chronic diseases. The prevalence of high risk for OSAHS, excessive daytime sleepiness and multimorbidity was 33.5, 11.6 and 63.9 %, respectively. None of the study subjects had a confirmed diagnosis for OSAHS prior to this study. A marked dose–response association between a high pre-test likelihood for OSAHS and multimorbidity was noted in patients with two [adjusted odds ratio (OR) 3.13; 95 % confidence interval (CI) 1.85–5.30) and three or more (adjusted OR 4.22; 95 % CI 2.55–6.96) chronic morbidities, independently of age, sex and smoking status. This association persisted across different levels for OSAHS risk in the Berlin questionnaire, was insensitive to varying definitions of multimorbidity and more pronounced in patients with excessive daytime sleepiness. These findings point out that primary care physicians who care for elderly patients who present with several, common and burdensome, chronic diseases should expect to find this multimorbidity often coinciding with undetected, and therefore untreated, OSAHS. Thus it is crucial to consider OSAHS as an important co-morbidity in older adults and systematically screen for OSAHS in primary care practice.
    Full-text · Article · Jan 2016 · SpringerPlus
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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. "
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    ABSTRACT: Introduction: The Berlin questionnaire (BQ) is a common tool to screen for Obstructive Sleep Apnea (OSA) in the general population, but its application in the clinical sleep setting is still challenging. The aim of this study was to determine the specificity and sensitivity of the BQ compared to the apnea-hypopnea index obtained from polysomnography recordings obtained from a sleep clinic in Iran. Methods: We recruited 100 patients who were referred to the Sleep Disorders Research Center of Kermanshah University of Medical Sciences for the evaluation of suspected sleep-disorder breathing difficulties. Patients completed a Persian version of BQ and underwent one night of PSG. For each patient, Apnea-Hypopnea Index (AHI) was calculated to assess the diagnosis and severity of OSA. Severity of OSA was categorized as mild when AHI was between 5 and 15, moderate when it was between 15 and 30, and severe when it was more than 30. Results: BQ results categorized 65% of our patients as high risk and 35% as low risk for OSA. The sensitivity and the specificity of BQ for OSA diagnosis with AHI>5 were 77.3% and 23.1%, respectively. Positive predictive value was 68.0% and negative predictive value was 22.0%. Moreover, the area under curve was 0.53 (95% CI: 0.49-0.67, P=0.38). Discussion: Our findings suggested that BQ, despite its advantages in the general population, is not a precise tool to determine the risk of sleep apnea in the clinical setting, particularly in the sleep clinic population.
    Full-text · Article · Jan 2016 · Basic and Clinical Neuroscience
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