title: Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients.
abstract: BACKGROUND
  Because of the high prevalence of obstructive sleep apnea (OSA) and its adverse impact on perioperative outcome, a practical screening tool for surgical patients is required. This study was conducted to validate the Berlin questionnaire and the American Society of Anesthesiologists (ASA) checklist in surgical patients and to compare them with the STOP questionnaire.
  
  
  METHODS
  After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. The scores from the Berlin questionnaire, ASA checklist, and STOP questionnaire were evaluated versus the apnea-hypopnea index from in-laboratory polysomnography. The perioperative data were collected through chart review.
  
  
  RESULTS
  Of 2,467 screened patients, 33, 27, and 28% were respectively classified as being at high risk of OSA by the Berlin questionnaire, ASA checklist, and STOP questionnaire. The performance of the screening tools was evaluated in 177 patients who underwent polysomnography. The sensitivities of the Berlin questionnaire, ASA checklist, and STOP questionnaire were 68.9-87.2, 72.1-87.2, and 65.6-79.5% at different apnea-hypopnea index cutoffs. There was no significant difference between the three screening tools in the predictive parameters. The patients with an apnea-hypopnea index greater than 5 and the patients identified as being at high risk of OSA by the STOP questionnaire or ASA checklist had a significantly increased incidence of postoperative complications.
  
  
  CONCLUSIONS
  Similar to the STOP questionnaire, the Berlin questionnaire and ASA checklist demonstrated a moderately high level of sensitivity for OSA screening. The STOP questionnaire and the ASA checklist were able to identify the patients who were likely to develop postoperative complications.
authors.affiliation: Department of Anesthesia, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. frances.chung@uhn.on.ca
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
authors.forename: Balaji
authors.initials: B
authors.lastname: Yegneswaran
authors.forename: Pu
authors.initials: P
authors.lastname: Liao
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Chung
authors.forename: Santhira
authors.initials: S
authors.lastname: Vairavanathan
authors.forename: Sazzadul
authors.initials: S
authors.lastname: Islam
authors.forename: Ali
authors.initials: A
authors.lastname: Khajehdehi
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D000368:Aged; D000776:Anesthesiology / Q000379:methods*; D001604:Berlin; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000503:physiopathology*; D012955:Societies, Medical; D013514:Surgical Procedures, Operative / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States