Skip to main content
SpringerLink
Log in

The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

The Berlin questionnaire (BQ) has been used to help identify patients at high risk of having sleep apnea in primary care and atrial fibrillation patients. The BQ may be a useful adjunct in sleep medicine and research, but it has never been validated in a sleep clinic population. The aim of the study is to determine the specificity and sensitivity of the BQ compared to the respiratory disturbance index (RDI) values obtained from two nights of polysomnographic recording in a sleep clinic population. This is a retrospective chart review study of 130 sleep clinic patients. Patients’ demographics, BQ scores, RDI measurements, and sleep study parameters were extracted from the patients’ chart. Of the 130 charts reviewed, the BQ identified 76 (58.5%) as being at high-risk of having sleep apnea, but overnight polysomnography found only 34 of the 130 patients (26.2%) had an RDI > 10. The BQ performed with 0.62 sensitivity and 0.43 specificity at the RDI > 10 level. Due to the low sensitivity and specificity as well as the large number of false negatives and positives, the Berlin questionnaire is not an appropriate instrument for identifying patients with sleep apnea in a sleep clinic population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20(9):705–706 (Sep)

    PubMed  CAS  Google Scholar 

  2. Bahammam A, Delaive K, Ronald J, Manfreda J, Roos L, Kryger MH (1999) Health care utilization in males with obstructive sleep apnea syndrome two years after diagnosis and treatment. Sleep 22(6):740–747 (Sep 15)

    PubMed  CAS  Google Scholar 

  3. Bixler EO, Vgontzas AN, Lin HM, et al (2000) Association of hypertension and sleep-disordered breathing. Arch Intern Med 160(15):2289–2295

    Article  PubMed  CAS  Google Scholar 

  4. Dyken ME, Somers VK, Yamada T, Ren ZY, Zimmerman MB (1996) Investigating the relationship between stroke and obstructive sleep apnea. Stroke 27(3):401–407 (Mar 1)

    PubMed  CAS  Google Scholar 

  5. He J, Kryger MH, Zorick FJ, Conway W, Roth T (1988) Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 94(1):9–14 (Jul)

    Article  PubMed  CAS  Google Scholar 

  6. Hung J, Whitford EG, Parsons RW, Hillman DR (1990) Association of Sleep–Apnea with Myocardial-Infarction in Men. Lancet 336(8710):261–4 (Aug 4)

    Article  PubMed  CAS  Google Scholar 

  7. Riley RW, Powell NB, Guilleminault C, Clerk A, Troell R (1995) Obstructive sleep apnea. Trends in therapy. West J Med 162(2):143–148 (Feb)

    PubMed  CAS  Google Scholar 

  8. Stepnowsky C, Orr W, Davidson T (2004) Nightly variability of sleep-disordered breathing measured over 3 nights. Otolaryngol Head Neck Surg 131(6):837–843 (Dec)

    Article  PubMed  Google Scholar 

  9. Ford DE, Kamerow DB (1989) Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 262(11):1479–1484. (Sep 15)

    Article  PubMed  CAS  Google Scholar 

  10. Lu CL, Lee YC, Tsai SJ, Hu PG, Sim CB (1995) Psychiatric disturbances associated with hyperthyroidism: an analysis report of 30 cases. Zhonghua Yi Xue Za Zhi (Taipei) 56(6):393–398 (Dec)

    CAS  Google Scholar 

  11. Guilleminault C, Czeisler C, Coleman R, Miles L (1982) Circadian rhythm disturbances and sleep disorders in shift workers. Electroencephalogr Clin Neurophysiol Suppl 36:709–714

    PubMed  CAS  Google Scholar 

  12. Melamed S, Oksenberg A (2002) Excessive daytime sleepiness and risk of occupational injuries in non-shift daytime workers. Sleep 25(3):315–322 (May 1)

    PubMed  Google Scholar 

  13. Bassetti CL (2005) Sleep and stroke. Semin Neurol 25(1):19–32 (Mar)

    Article  PubMed  Google Scholar 

  14. Thorpy MJ (2004) Sleep disorders in Parkinson’s disease. Clin Cornerstone 6(Suppl 1A):S7–S15

    Article  PubMed  Google Scholar 

  15. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491 (Oct 5)

    PubMed  CAS  Google Scholar 

  16. Strauss R, Browner W. (2000) Letter to the editor: sensitivity, specificity and positive predictive value of Berlin Questionnaire. Ann Intern Med 132(9):758–759

    PubMed  CAS  Google Scholar 

  17. Guilleminault C, Dement WC (1977) 235 cases of excessive daytime sleepiness. Diagnosis and tentative classification. J Neurol Sci 31(1):13–27 (Jan)

    Article  PubMed  CAS  Google Scholar 

  18. Chervin RD (2000) Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 118(2):372–379 (Aug)

    Article  PubMed  CAS  Google Scholar 

  19. Balan S, Spivak B, Mester R, Leibovitz A, Habot B, Weizman A (1998) Psychiatric and polysomnographic evaluation of sleep disturbances. J Affect Disord 49(1):27–30 (Apr)

    Article  PubMed  CAS  Google Scholar 

  20. Zwillich CW, Pickett C, Hanson FN, Weil JV (1981) Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis 124(2):158–60 (Aug)

    PubMed  CAS  Google Scholar 

  21. Rechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. 1968. Washington, US Department of Health, Education and Welfare, National Institute of Health [Ref Type: Serial (Book, Monograph)]

  22. Sleep-related breathing disorders in adults (1999) recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22(5):667–689 (Aug 1)

  23. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545 (Dec)

    PubMed  CAS  Google Scholar 

  24. Johns M, Hocking B (1997) Daytime sleepiness and sleep habits of Australian workers. Sleep 20(10):844–849 (Oct)

    PubMed  CAS  Google Scholar 

  25. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46(10):1121–1123 (Oct)

    PubMed  CAS  Google Scholar 

  26. Soldatos CR, Dikeos DG, Paparrigopoulos TJ (2003) The diagnostic validity of the Athens Insomnia Scale. J Psychosom Res 55(3):263–277 (Sep)

    Article  PubMed  Google Scholar 

  27. Radloff L (1977) The CES-D scale: a self-report depression scale for research in the general population. App Psychol Meas 385–401 (Ref Type: Generic)

  28. Rowley JA, Aboussouan LS, Badr MS (2000) The use of clinical prediction formulas in the evaluation of obstructive sleep apnea. Sleep 23(7):929–938 (Nov 1)

    PubMed  CAS  Google Scholar 

  29. Maislin G, Pack AI, Kribbs NB, et al (1995) A survey screen for prediction of apnea. Sleep 18(3):158–166 (Apr)

    PubMed  CAS  Google Scholar 

  30. Mustafa M, Erokwu N, Ebose I, Strohl K (2005) Sleep problems and the risk for sleep disorders in an outpatient veteran population. Sleep Breath 9(2):57–63 (Jun)

    Article  PubMed  Google Scholar 

  31. Principe-Rodriguez K, Strohl KP, Hadziefendic S, Pina IL (2005) Sleep symptoms and clinical markers of illness in patients with heart failure. Sleep Breath 9(3):127–133 (Sep)

    Article  PubMed  Google Scholar 

  32. Ogretmenoglu O, Suslu AE, Yucel OT, Onerci TM, Sahin A (2005) Body fat composition: a predictive factor for obstructive sleep apnea. Laryngoscope 115(8):1493–1498 (Aug)

    Article  PubMed  Google Scholar 

  33. Gami AS, Pressman G, Caples SM, et al (2004) Association of atrial fibrillation and obstructive sleep apnea. Circulation 110(4):364–367 (Jul 27)

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to extend their thanks and appreciation to the following who contributed their invaluable statistical efforts to this paper: Ryan Browne, Rachel Chu, Yin Cui, Matthew Davis, MingXia Deng, Meng Du, Shuyu Fan, Lin Fang, Kimberly Fernandes, Charlotte Grieve,David Han, Dan He, Lei He, Shahedul Ahsan Khan, Linglong Kong, Zi Jin, Longhai Li, Song Li, Yuanyuan Liang, Kristen Maddalena, Jesse Raffa, Enayetur Raheem, Rena (Jie) Sun, Li Wang, Mengzhe Wang, Weiling Wang, Yaling Yin, Erik Youngson, Fei Yuan, Cynthia (Xin) Zheng, Michelle Zhou, and Qiaohao Zhu.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Toronto Western Hospital, 399 Bathurst Street, 7M-429, Toronto, ON, M5T 2S8, Canada

    Negar Ahmadi, Sharon A. Chung & Colin M. Shapiro

  2. Department of Statistics, University of Toronto, Toronto, ON, Canada

    Alison Gibbs

Authors
  1. Negar Ahmadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sharon A. Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alison Gibbs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Colin M. Shapiro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sharon A. Chung.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ahmadi, N., Chung, S.A., Gibbs, A. et al. The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath 12, 39–45 (2008). https://doi.org/10.1007/s11325-007-0125-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-007-0125-y

Keywords

Search

Navigation