title: Translation of Berlin Questionnaire to Portuguese language and its application in OSA identification in a sleep disordered breathing clinic.
abstract: BACKGROUND
  Berlin Questionnaire (BQ), an English language screening tool for obstructive sleep apnea (OSA) in primary care, has been applied in tertiary settings, with variable results.
  
  
  OBJECTIVE
  Development of BQ Portuguese version and evaluation of its utility in a sleep disordered breathing clinic (SDBC).
  
  
  METHODS
  BQ was translated using back translation methodology and prospectively applied, previously to cardiorespiratory sleep study, to 95 consecutive subjects, referred to a SDBC, with OSA suspicion. OSA risk assessment was based on responses in 10 items, organized in 3 categories: snoring and witnessed apneas (category 1), daytime sleepiness (category 2), high blood pressure (HBP)/obesity (category 3).
  
  
  RESULTS
  In the studied sample, 67.4 % were males, with a mean age of 51 ± 13 years. Categories 1, 2 and 3 were positive in 91.6, 24.2 and 66.3 %, respectively. BQ identified 68.4 % of the patients as being in the high risk group for OSA and the remaining 31.6 % in the low risk. BQ sensitivity and specificity were 72.1 and 50 %, respectively, for an apnea-hipopnea index (AHI) > 5, 82.6 and 44.8 % for AHI > 15, 88.4 and 39.1 % for AHI > 30. Being in the high risk group for OSA did not influence significantly the probability of having the disease (positive likelihood ratio [LR] between 1.44-1.49). Only the items related to snoring loudness, witnessed apneas and HBP/obesity presented a statistically positive association with AHI, with the model constituted by their association presenting a greater discrimination capability, especially for an AHI > 5 (sensitivity 65.2 %, specificity 80 %, positive LR 3.26).
  
  
  CONCLUSIONS
  The BQ is not an appropriate screening tool for OSA in a SDBC, although snoring loudness, witnessed apneas, HBP/obesity have demonstrated being significant questionnaire elements in this population.
authors.affiliation: Department of Pulmonology, H.S. Joao, Porto, Portugal. vaz.anapaula@gmail.com
authors.forename: A P
authors.initials: AP
authors.lastname: Vaz
authors.forename: M
authors.initials: M
authors.lastname: Drummond
authors.forename: P Caetano
authors.initials: PC
authors.lastname: Mota
authors.forename: M
authors.initials: M
authors.lastname: Severo
authors.forename: J
authors.initials: J
authors.lastname: Almeida
authors.forename: J Carlos
authors.initials: JC
authors.lastname: Winck
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D055815:Young Adult