Articles
15 August 2000

Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome

Publication: Annals of Internal Medicine
Volume 131, Number 7

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.

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References

1.
Redline SStrohl KP. Recognition and consequences of obstructive sleep apnea hypopnea syndrome. Clin Chest Med. 1998;19:1-19.
2.
Young TPalta MDempsey JSkatrud JWeber SBadr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-5.
3.
Marin JMGascon JMCarrizo SGispert J. Prevalence of sleep apnoea syndrome in the Spanish adult population. Int J Epidemiol. 1997;26:381-6.
4.
Olson LGKing MTHensley MJSaunders NA. A community study of snoring and sleep disordered breathing. Prevalence. Am J Respir Crit Care Med. 1995;152:711-6.
5.
Ohayon MMGuilleminault CPriest RGCaulet M. Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ. 1997;314:860-3.
6.
Young TEvans LFinn LPalta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20:705-6.
7.
Ball EMSimon RD JrTall AABanks MBNino-Murcia GDement WC. Diagnosis and treatment of sleep apnea within the community. The Walla Walla project. Arch Intern Med. 1997;157:419-24.
8.
Haponik EFFrye AWRichards BWymer AHinds APearce Ket al . Sleep history is neglected diagnostic information. Challenges for primary care physicians. J Gen Intern Med. 1996;11:759-61.
9.
Cirigniotta FD'Alessandro RPartinen MZucconi MCristina EGerardi Ret al . Prevalence of every night snoring and obstructive sleep apnoeas among 30-69-year-old men in Bologna, Italy. Acta Neurol Scand. 1989;79:366-72.
10.
Kapuniai LEAndrew DJCrowell DHPearce JW. Identifying sleep apnea from self reports. Sleep. 1988;11:430-6.
11.
Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med. 1994; 150(5 Pt 1):1279-85.
12.
Flemons WWRemmers JE. The diagnosis of sleep apnea: questionnaires and home studies. Sleep. 1996;19 10 Suppl S243-7.
13.
Kump KWhalen CTishler PVBrowner IFerrette VStrohl KPet al . Assessment of the validity and utility of a sleep-symptom questionnaire. Am J Respir Crit Care Med. 1994;150:735-41.
14.
Wu HYan-Go F. Self-reported automobile accidents involving patients with obstructive sleep apnea. Neurology. 1996;46:1254-7.
15.
Maislin GPack AIKribbs NBSmith PLSchwartz ARKline LRet al . A survey screen for prediction of apnea. Sleep. 1995;18:158-66.
16.
Sackett DL. A primer on the precision and accuracy of the clinical examination. JAMA. 1992;267:2638-44.
17.
AASM Task Force report. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999; 22:667-90.
18.
Stoohs RABarger KDement WC. Sleep disordered breathing in primary care medicine. Sleep and Breathing. 1997;2:11-22.
19.
Kuczmarski RJFlegal KMCampbell SMJohnson CL. Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA. 1994;272:205-11.
20.
Logue ESmucker EDBourguet CC. Identification of obesity: waistlines or weight? Nutrition, Exercise, and Obesity Research Group. J Fam Pract. 1995;41:357-63.
21.
Young TBlustein JFinn LPalta M. Sleep-disordered breathing and motor vehicle accidents in a population based sample of employed adults. Sleep. 1997;20:608-13.
22.
Briones BAdams NStrauss MRosenberg CWhalen CCarskadon Met al . Relationship between sleepiness and general health status. Sleep. 1996;19:583-8.
23.
Lyznicki JMDoege TCDavis RMWilliams MA. Sleepiness, driving, and motor vehicle crashes. Council on Scientific Affairs, American Medical Association. JAMA. 1998;279:1908-13.
24.
American Thoracic Society/American Sleep Disorders Association. Statement on health outcomes research in sleep apnea. Am J Respir Crit Care Med. 1998; 157:335-41.

Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 131Number 75 October 1999
Pages: 485 - 491

History

Published in issue: 5 October 1999
Published online: 15 August 2000

Keywords

Authors

Affiliations

Nikolaus C. Netzer, MD
From Center for Sleep Education and Research, Case Western Reserve University, Cleveland, Ohio; and Sleep Disorders Research Center, Stanford University, Palo Alto, California.
Riccardo A. Stoohs, MD
From Center for Sleep Education and Research, Case Western Reserve University, Cleveland, Ohio; and Sleep Disorders Research Center, Stanford University, Palo Alto, California.
Cordula M. Netzer
From Center for Sleep Education and Research, Case Western Reserve University, Cleveland, Ohio; and Sleep Disorders Research Center, Stanford University, Palo Alto, California.
Kathryn Clark
From Center for Sleep Education and Research, Case Western Reserve University, Cleveland, Ohio; and Sleep Disorders Research Center, Stanford University, Palo Alto, California.
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.
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.
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.
Corresponding Author: 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, [email protected].
Current Author Addresses: Dr. Netzer and Ms. Netzer: Universitätsklinikum Ulm, Steinhovelstrasse 9, 89071 Ulm, Germany.
Dr. Stoohs: Sleep Disorders Clinic, Stanford University, 701 Welch Road, Palo Alto, CA 94304.
Ms. Clark and Dr. Strohl: Case Western Reserve University, 10701 East Boulevard, Cleveland, OH 44106.

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Nikolaus C. Netzer, Riccardo A. Stoohs, Cordula M. Netzer, et al. Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome. Ann Intern Med.1999;131:485-491. doi:10.7326/0003-4819-131-7-199910050-00002

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