title: Diagnostic accuracy of the Berlin questionnaire in detecting obstructive sleep apnea in patients with resistant hypertension.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) is strongly associated with resistant hypertension. The Berlin questionnaire is the most widely used screening tool to identify patients at high risk of having OSA. The objective was to test the diagnostic accuracy of the Berlin questionnaire in detecting OSA in resistant hypertensive patients.
  
  
  METHODS
  A cross-sectional analysis of 422 resistant hypertensive patients [31% men; mean (SD) age 62.4 (9.9) years] submitted to polysomnography (PSG), in whom the Berlin questionnaire was previously applied. OSA was defined by an apnea-hypopnea index of at least 5 per hour and moderate-to-severe OSA by an apnea-hypopnea index of at least 15. Statistical analysis included bivariate comparisons between patients at high and low risk by the Berlin questionnaire, and logistic regression to assess the predictors of agreement between the Berlin questionnaire and PSG. Sensitivity, specificity, positive and negative predictive values and likelihood ratios for the Berlin questionnaire in detecting OSA were calculated.
  
  
  RESULTS
  OSA was diagnosed in 347 patients (82.2%) and moderate-to-severe OSA in 234 patients (55.5%). In patients at high risk, moderate-to-severe OSA was confirmed in 58.3%, whereas in those at low risk, it was excluded in 50.4%. The accuracy of the Berlin questionnaire in detecting OSA was 55.6%. The specificity, sensitivity, positive and negative predictive value of the Berlin questionnaire in detecting moderate-to-severe OSA was 40, 69, 58 and 50%, respectively. The positive and negative likelihood ratios were 1.15 and 0.78, with a very low agreement (kappa = 0.081).
  
  
  CONCLUSIONS
  In a large cohort of resistant hypertensive patients, the Berlin questionnaire had a low accuracy of identifying patients with OSA and should not be used as a screening method for selecting patients to PSG.
authors.affiliation: Hypertension Program, University Hospital Clementino Fraga Filho, Medical School, Universidade Federal do Rio de Janeiro, Brazil.
authors.forename: Victor S
authors.initials: VS
authors.lastname: Margallo
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Muxfeldt
authors.forename: Gleison M
authors.initials: GM
authors.lastname: Guimarães
authors.forename: Gil F
authors.initials: GF
authors.lastname: Salles
mesh_terms: D000368:Aged; D001604:Berlin; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017286:Polysomnography; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis*; D011795:Surveys and Questionnaires