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Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome
- Nikolaus C. Netzer, MD;
- Riccardo A. Stoohs, MD;
- Cordula M. Netzer;
- Kathryn Clark; and
- Kingman P. Strohl, MD
- From Center for Sleep Education and Research, Case Western Reserve University, Cleveland, Ohio; and Sleep Disorders Research Center, Stanford University, Palo Alto, California.
Abstract
Background: Although sleep apnea is common, it often goes undiagnosed in primary care encounters.
Objective: To test the Berlin Questionnaire as a means of identifying patients with sleep apnea.
Design: Survey followed by portable, unattended sleep studies in a subset of patients.
Setting: Five primary care sites in Cleveland, Ohio.
Patients: 744 adults (of 1008 surveyed [74%]), of whom 100 underwent sleep studies.
Measurements: 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]).
Results: 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.
Conclusion: The Berlin Questionnaire provides a means of identifying patients who are likely to have sleep apnea.
Article and Author Information
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Acknowledgments: The authors thank the physicians participating in this study: Drs. Douglas Flagg, Charles Pavluk, Timothy Reed, David Rosenberg, John Thomas, and Michael Nochomovitz. Dr. Bruce Wilkenfeld provided surveys of practice demographics. They also thank Dr. Susan Redline for her strategic advice and encouragement, Chris Burant for help with the statistical models, and Dr. Amy Justice for review of the manuscript.
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Grant Support: The Cleveland study was supported in part by Mallinckrodt (formerly Nellcor Puritan Bennett); 3M, Inc.; the Brendan Schmittman Foundation (Cologne, Germany); the University Primary Care Practice (Cleveland, Ohio); the National Institutes of Health (grants HL-03650 and HL-42215) and the Department of Veterans Affairs Medical Service.
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Requests for Reprints: Kingman P. Strohl, MD, Case Western Reserve University, 10701 East Boulevard, Cleveland, OH 44106. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
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Current Author Addresses: Dr. Netzer and Ms. Netzer: Universitätsklinikum Ulm, Steinhovelstrasse 9, 89071 Ulm, Germany.
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Dr. Stoohs: Sleep Disorders Clinic, Stanford University, 701 Welch Road, Palo Alto, CA 94304.
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Ms. Clark and Dr. Strohl: Case Western Reserve University, 10701 East Boulevard, Cleveland, OH 44106.
- Copyright ©2004 by the American College of Physicians
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