title: Utility of the Berlin questionnaire for predicting obstructive sleep apnea in individuals with treatment-resistant depression.
abstract: OBJECTIVE
  Obstructive sleep apnea is a disabling sleep disorder characterized by obstructions or near obstructions of the upper airway. Sleep apnea shares many common features with major depressive disorder, which is a serious psychiatric disorder that can persist despite multiple treatment attempts. The current study utilizes baseline data from a study designed to evaluate the effectiveness of continuous positive airway pressure treatment in patients with comorbid treatment-resistant depression and sleep apnea. The aim of this study is to examine the effectiveness of the Berlin questionnaire in predicting which individuals with treatment-resistant depression have obstructive sleep apnea.
  
  
  METHODS
  Eighty-two outpatients with treatment-resistant depression completed the Berlin questionnaire and underwent overnight polysomnography to determine whether they were suffering from undiagnosed obstructive sleep apnea.
  
  
  RESULTS
  Scoring in the high-risk category on the Berlin questionnaire predicted an apnea/hypopnea index greater than 5 with a sensitivity of 25 % and a specificity of 85.4 %, an apnea/hypopnea index greater than 10 with a sensitivity of 24.5 % and a specificity of 91.7 %, and an apnea/hypopnea index greater than 15 with a sensitivity of 22.2 % and a specificity of 92.9 %. The Berlin questionnaire was better at predicting the presence of sleep apnea in our sample of predominantly pre-menopausal women than men, and category 2 of the questionnaire (daytime somnolence) was the poorest predictor of sleep apnea.
  
  
  CONCLUSIONS
  The Berlin questionnaire appears to be a valid instrument for ruling out obstructive sleep apnea in treatment-resistant depression and may be a helpful tool in assisting with the allocation of diagnostic resources.
authors.affiliation: Department of Psychology, Queen's University, Kingston, Canada.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Best
authors.forename: Michael
authors.initials: M
authors.lastname: Fitzpatrick
authors.forename: Roumen
authors.initials: R
authors.lastname: Milev
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Bowie
authors.forename: Ruzica
authors.initials: R
authors.lastname: Jokic
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D061218:Depressive Disorder, Treatment-Resistant / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017286:Polysomnography; D017697:Premenopause / Q000523:psychology; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires