Is the Berlin questionnaire a useful tool to diagnose sleep apnea in the elderly?

Service de Physiologie Clinique et de l'Exercice, CHU Nord, Saint-Etienne, Faculté de Médecine Jacques Lisfranc, PRES Université de Lyon 42023, Université Jean Monnet, Saint-Etienne, France.
Sleep Medicine (Impact Factor: 3.15). 02/2011; 12(2):142-6. DOI: 10.1016/j.sleep.2010.09.004
Source: PubMed


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.

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    • "As discrepancies between objective and subjective measure of sleep are common in BD [13], we regarded the examination of the associations between BMI and PSQI total score as secondary analysis. The Berlin Questionnaire is a validated assessment of an individual's risk of Obstructive Sleep Apnea (OSA) [31]. Since a substantial proportion of obese individual and patients with BD who are overweight are known to present with OSA [35], we included this as a putative moderating variable in our analysis. "

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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.[35] Our study findings are also limited by the fact that subjects in non-OSA group were not evaluated with a sleep study. "
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