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Sleep Related Questionnaires

Home ▶ Members ▶ Assemblies and Sections ▶ Assemblies ▶ Sleep and Respiratory Neurobiology ▶ Sleep Related Questionnaires ▶ Berlin questionnaire


Berlin questionnaire
Name of questionnaire Berlin Questionnaire
Type of questionnaire Self-administered questionnaire
Number of items 10
Number of domains & categories 3 categories
Name of categories/domains
  1. Snoring and witnessed apnea (5 questions)
  2. Excessive daytime sleepiness (4 questions)
  3. History of high blood pressure or obesity (1 question plus height and weight)
Scaling of items Each category’s responses are scored as positive/negative; two or more positive categories indicate high likelihood of sleep disordered breathing
Scoring available: with permission or free With permission from Dr. Netzer.
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 cutoff and OSA prevalence. A meta-analysis showed reasonable sensitivity of 79% (AHI ≥5/hour) and 82% (AHI ≥15/hour), but low specificity of 32-53% (AHI ≥5/hour) and 35-39% (AHI ≥15/hour) in sleep clinic population [6], suggesting this questionnaire may be a useful screening tool.
Validity Yes
Language English
Translations in other languages (if yes, then list the languages) Arabic, Chinese, Dutch, French, Greek, Hindi, Indian, Korean, Malay, Persian, Portuguese, Serbian, Thai, Turkish [2,4,7-14]
Developer name Nikolaus C Netzer, MD PhD
Developer contact information nikinetzer@yahoo.com
Availability of questionnaire: needs permission from developer, cost or freely available With permission from Dr. Netzer.
Limitations More sensitive then specific.
Link to the questionnaire (if available) With Permission: https://www-acpjournals-org.proxy.cc.uic.edu/doi/pdf/10.7326%2F0003-4819-131-7-199910050-00002
Other comments In general, more sensitive then specific, but characteristics vary widely depending on the population tested [6,15]. Low sensitivity in Black American sample [16]. High specificity (>90%) for OSA in those with treatment resistant depression [17]. Meta-analyses have shown lower sensitivity compared to other screening questionnaires such as STOP-BANG [15,18,19]. Recent meta-analysis of 6 studies reported pooled sensitivity of 0.66 (0.45-0.83) and specificity of 0.62 (0.48-0.75) in pregnant population [20]. However, wide variability of reported sensitivity and specificity among the studies can be from differences in duration of pregnancy [20].
Patient populations in whom questionnaire has been validated General population, primary care and sleep clinic settings, elderly, surgical patients. Subjects with ACS, CKD, DM, stroke, migraine, atrial fibrillation, PCOS, commercial drivers.
Citations
  1. Netzer, N.C.; Stoohs, R.A.; Netzer, C.M.; Clark, K.; Strohl, K.P. 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.
  2. Saengsuwan, J.; Ungtrakul, N.; Saengsuwan, J.; Sawanyawisuth, K. Preliminary validity and reliability of a Thai Berlin questionnaire in stroke patients. BMC Res Notes 2014, 7, 348, doi:10.1186/1756-0500-7-348.
  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, M.B.; Milovanovic, A.; Nagorni-Obradovic, L.; Nesic, D.; Milovanovic, J.; Milovanovic, A.P.S. Screening commercial drivers for obstructive sleep apnea: translation and validation of Serbian version of Berlin Questionnaire. Qual Life Res 2016, 25, 343-349, doi:10.1007/s11136-015-1087-3.
  5. Chung, F.; Yegneswaran, B.; Liao, P.; Chung, S.A.; Vairavanathan, S.; Islam, S.; Khajehdehi, A.; Shapiro, C.M. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 2008, 108, 822-830, doi:10.1097/ALN.0b013e31816d91b5.
  6. Senaratna, C.V.; Perret, J.L.; Matheson, M.C.; Lodge, C.J.; Lowe, A.J.; Cassim, R.; Russell, M.A.; Burgess, J.A.; Hamilton, G.S.; Dharmage, S.C. Validity of the Berlin questionnaire in detecting obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2017, 36, 116-124, doi:10.1016/j.smrv.2017.04.001.
  7. Bouloukaki, I.; Komninos, I.D.; Mermigkis, C.; Micheli, K.; Komninou, M.; Moniaki, V.; Mauroudi, E.; Siafakas, N.M.; Schiza, S.E. Translation and validation of Berlin questionnaire in primary health care in Greece. BMC Pulm Med 2013, 13, 6, doi:10.1186/1471-2466-13-6.
  8. 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. Chin Med J (Engl) 2014, 127, 3065-3070.
  9. 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, 334-339.
  10. 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, 5-11.
  11. Kang, K.; Park, K.S.; Kim, J.E.; Kim, S.W.; Kim, Y.T.; Kim, J.S.; Lee, H.W. Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study. Sleep Breath 2013, 17, 803-810, doi:10.1007/s11325-012-0767-2.
  12. Saleh, A.B.; Ahmad, M.A.; Awadalla, N.J. Development of Arabic version of Berlin questionnaire to identify obstructive sleep apnea at risk patients. Ann Thorac Med 2011, 6, 212-216, doi:10.4103/1817-1737.84775.
  13. Sforza, E.; Chouchou, F.; Pichot, V.; Herrmann, F.; Barthelemy, J.C.; Roche, F. Is the Berlin questionnaire a useful tool to diagnose obstructive sleep apnea in the elderly? Sleep Med 2011, 12, 142-146, doi:10.1016/j.sleep.2010.09.004.
  14. Gupta, R.; Ali, R.; Dhyani, M.; Das, S.; Pundir, A. Hindi translation of Berlin questionnaire and its validation as a screening instrument for obstructive sleep apnea. J Neurosci Rural Pract 2016, 7, 244-249, doi:10.4103/0976-3147.176187.
  15. Bernhardt, L.; Brady, E.M.; Freeman, S.C.; Polmann, H.; Reus, J.C.; Flores-Mir, C.; De Luca Canto, G.; Robertson, N.; Squire, I.B. Diagnostic accuracy of screening questionnaires for obstructive sleep apnoea in adults in different clinical cohorts: a systematic review and meta-analysis. Sleep Breath 2022, 26, 1053-1078, doi:10.1007/s11325-021-02450-9.
  16. Holliday, S.B.; Haas, A.; Dong, L.; Ghosh-Dastidar, M.; Hale, L.; Buysse, D.J.; Dubowitz, T.; Troxel, W.M. Examining the diagnostic validity of the Berlin Questionnaire in a low-income Black American sample. J Clin Sleep Med 2021, 17, 1987-1994, doi:10.5664/jcsm.9388.
  17. Best, M.W.; Fitzpatrick, M.; Milev, R.; Bowie, C.R.; Jokic, R. Utility of the Berlin questionnaire for predicting obstructive sleep apnea in individuals with treatment-resistant depression. Sleep Breath 2013, 17, 1221-1227, doi:10.1007/s11325-013-0827-2.
  18. Jonas, D.E.; Amick, H.R.; Feltner, C.; Weber, R.P.; Arvanitis, M.; Stine, A.; Lux, L.; Harris, R.P. Screening for Obstructive Sleep Apnea in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2017, 317, 415-433, doi:10.1001/jama.2016.19635.
  19. Amra, B.; Rahmati, B.; Soltaninejad, F.; Feizi, A. Screening Questionnaires for Obstructive Sleep Apnea: An Updated Systematic Review. Oman Med J 2018, 33, 184-192, doi:10.5001/omj.2018.36.
  20. Tantrakul, V.; Numthavaj, P.; Guilleminault, C.; McEvoy, M.; Panburana, P.; Khaing, W.; Attia, J.; Thakkinstian, A. Performance of screening questionnaires for obstructive sleep apnea during pregnancy: A systematic review and meta-analysis. Sleep Med Rev 2017, 36, 96-106, doi:10.1016/j.smrv.2016.11.003.
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Updated by Ikuyo Imayama, MD
Last update October 2022