Sleep Related Questionnaires

Berlin questionnaire

Name of questionnaire Berlin questionnaire (1)
Type of questionnaire Identify patients with sleep apnea in general population, primary care and sleep clinic settings, elderly, those with ACS, CKD, DM, stroke, migraine, atrial fibrillation, PCOS, commercial drivers
Number of items 10
Number of domains & categories 3
Name of categories/domains Snoring severity, excessive daytime sleepiness, history of high blood pressure or obesity.
Scaling of items Variable
Scoring available: with permission or free With permission from Annals of Internal Medicine
Scoring test-retest reliability Variable: 0.74 – 0.98 (Cohen's kappa) (2-4)
Scoring Internal consistency Variable: 0.68 - 0.98 (Cronbach's alpha) (2-5)
Test characteristics Dependent on setting, location, OSA diagnostic cut off (i.e. AHI > 5 or 15) and prevalence. Overall, the likelihood ratios (LR) are modest (LR+ < 2.5 and LR- > 0.2).(6-8) In selected studies: in primary care, the sensitivity and specificity were 86% and 77% respectively (AHI > 5 cutoff), and 54% and 97% (AHI > 15 cutoff) (1); in general population, sensitivity and specificity were 37% and 84% (AHI > 5), and 43% and 80% (AHI >15) (6); in sleep clinic population, with higher OSA prevalence, positive predictive value (PPV) and negative predictive values (NPV) range between 85-96% and 26-34% respectively (AHI > 5) (9-11), while PPV and NPV range 58-73% and 49-58% respectively for AHI > 15 cutoff (10-13).
Validity Yes, in medical and surgical patients
Language English
Translations in other languages (if yes, then list the languages) Arabic, Chinese, Dutch, French, Greek, Indian, Korean, Malay, Persian, Portuguese, Serbian, Thai and Turkish languages (2, 4, 9, 10, 14-18)
Developer name NC Netzer, MD, et al.
Developer contact information nikinetzer@yahoo.com
Availability of questionnaire: needs permission from developer, cost or freely available With permission from American College of Physicians
Limitations Can be time consuming as responses need to be scored using an answer key. Not specifically validated in African American or Latino populations.
Link to the questionnaire (if available) http://cpap.1800cpap.com/tests/BerlinQuestionnaire.pdf
Other comments In general, more sensitive then specific, but characteristics vary widely depending on the population tested. Conflicting results in the gravid population (19, 20).  High specificity (>90%) for OSA in those with treatment resistant depression (21).
References (including original publication).
  1. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Annals of internal medicine. 1999;131(7):485-91.
  2. Saengsuwan J, Ungtrakul N, Saengsuwan J, Sawanyawisuth K. Preliminary validity and reliability of a Thai Berlin questionnaire in stroke patients. BMC research notes. 2014;7:348.
  3. Suksakorn S, Rattanaumpawan P, Banhiran W, Cherakul N, Chotinaiwattarakul W. Reliability and validity of a Thai version of the Berlin questionnaire in patients with sleep disordered breathing. J Med Assoc Thai. 2014;97 Suppl 3:S46-56.
  4. Popevic MB, Milovanovic A, Nagorni-Obradovic L, Nesic D, Milovanovic J, Milovanovic AP. Screening commercial drivers for obstructive sleep apnea: translation and validation of Serbian version of Berlin Questionnaire. Qual Life Res. 2015.
  5. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108(5):82230.
  6. Hrubos-Strom H, Randby A, Namtvedt SK, Kristiansen HA, Einvik G, Benth J, et al. A Norwegian population-based study on the risk and prevalence of obstructive sleep apnea. The Akershus Sleep Apnea Project (ASAP). Journal of sleep research. 2011;20(1 Pt 2):162-70.
  7. El-Sayed IH. Comparison of four sleep questionnaires for screening obstructive sleep apnea. Egyptian Journal of Chest Diseases and Tuberculosis. 2012;61(4):433-41.
  8. Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructive sleep apnea?: The Rational Clinical Examination systematic review. Jama. 2013;310(7):731-41.
  9. Bouloukaki I, Komninos ID, Mermigkis C, Micheli K, Komninou M, Moniaki V, et al. Translation and validation of Berlin questionnaire in primary health care in Greece. BMC pulmonary medicine. 2013;13:6.
  10. Luo J, Huang R, Zhong X, Xiao Y, Zhou J. STOP-Bang questionnaire is superior to Epworth sleepiness scales, Berlin questionnaire, and STOP questionnaire in screening obstructive sleep apnea hypopnea syndrome patients. Chinese medical journal. 2014;127(17):3065-70.
  11. Pataka A, Daskalopoulou E, Kalamaras G, Fekete Passa K, Argyropoulou P. Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic. Sleep medicine. 2014;15(7):776-81.
  12. Subramanian S, Hesselbacher SE, Aguilar R, Surani SR. The NAMES assessment: a novel combined-modality screening tool for obstructive sleep apnea. Sleep & breathing = Schlaf & Atmung. 2011;15(4):819-26.
  13. Yuceege M, Firat H, Sever O, Demir A, Ardic S. The effect of adding gender item to Berlin Questionnaire in determining obstructive sleep apnea in sleep clinics. Annals of thoracic medicine. 2015;10(1):25-8.
  14. Amra B, Nouranian E, Golshan M, Fietze I, Penzel T. Validation of the persian version of berlin sleep questionnaire for diagnosing obstructive sleep apnea. Int J Prev Med. 2013;4(3):334-9.
  15. Yunus A, Seet W, Mohamad Adam B, Haniff J. Validation of the Malay version of Berlin questionaire to identify Malaysian patients for obstructive sleep apnea. Malays Fam Physician. 2013;8(1):5-11.
  16. ]Kang K, Park KS, Kim JE, Kim SW, Kim YT, Kim JS, et al. Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study. Sleep & breathing = Schlaf & Atmung. 2013;17(2):803-10.
  17. Saleh AB, Ahmad MA, Awadalla NJ. Development of Arabic version of Berlin questionnaire to identify obstructive sleep apnea at risk patients. Annals of thoracic medicine. 2011;6(4):212-6.
  18. Sforza E, Chouchou F, Pichot V, Herrmann F, Barthelemy JC, Roche F. Is the Berlin questionnaire a useful tool to diagnose obstructive sleep apnea in the elderly? Sleep medicine. 2011;12(2):142-6.
  19. Wilson DL, Walker SP, Fung AM, O'Donoghue F, Barnes M, Howard M. Can we predict sleep-disordered breathing in pregnancy? The clinical utility of symptoms. Journal of sleep research. 2013;22(6):670-8.
  20. Antony KM, Agrawal A, Arndt ME, Murphy AM, Alapat PM, Guntupalli KK, et al. Obstructive sleep apnea in pregnancy: reliability of prevalence and prediction estimates. Journal of perinatology : official journal of the California Perinatal Association. 2014;34(8):587-93.
  21. Best MW, Fitzpatrick M, Milev R, Bowie CR, Jokic R. Utility of the Berlin questionnaire for predicting obstructive sleep apnea in individuals with treatment-resistant depression. Sleep & breathing = Schlaf & Atmung. 2013;17(4):1221-7.
   
Updated by Andrey Zinchuk, MD, BS
The last date of update 2015
Last Reviewed: November 2018