title: Using the Berlin Questionnaire to Predict Obstructive Sleep Apnea in the General Population.
abstract: OBJECTIVE
  The Berlin questionnaire is a self-administered questionnaire that was developed to identify subjects with obstructive sleep apnea (OSA) in primary care settings. This study evaluated the performance of the questionnaire to predict OSA in the general population.
  
  
  METHODS
  A sample of 242 subjects in a population-based cohort completed a home-based sleep study with an Embletta device (type 3 monitor). Subjects completed the Berlin questionnaire on the evening just prior to the sleep study. The sleep studies were manually scored according to the 2012 American Academy of Sleep Medicine (AASM) criteria.
  
  
  RESULTS
  The prevalence of moderate-to-severe and severe OSA defined as apnea-hypopnea index (AHI) of ≥ 15 and ≥ 30 was 28.1% and 10.7%, respectively. Seventy-nine subjects (32.6%) were classified as high risk according to the Berlin questionnaire. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the questionnaire to predict an AHI ≥ 15 was 58.8%, 77.6%, 82.9%, and 50.6%, respectively. The area under the receiving operator characteristic (ROC) curve for moderate-to-severe OSA was 0.682. When used to predict an AHI ≥ 30, the sensitivity of the questionnaire increased to 76.9% with a small drop in specificity to 72.7%. The corresponding NPV, PPV, and area under the ROC curve of the questionnaire to predict severe OSA were 96.3%, 25.3%, and 0.748, respectively.
  
  
  CONCLUSIONS
  The Berlin questionnaire may have utility in the general population setting as a screening tool for OSA in view of its good sensitivity and high NPV in ruling out severe OSA.
authors.affiliation: Department of Respiratory Medicine, Ng Teng Fong General Hospital, Jurong Health Services, Singapore.
authors.forename: Adeline
authors.initials: A
authors.lastname: Tan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System.
authors.forename: Jason D C
authors.initials: JD
authors.lastname: Yin
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System.
authors.forename: Linda W L
authors.initials: LW
authors.lastname: Tan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System.
authors.forename: Rob M
authors.initials: RM
authors.lastname: van Dam
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System.|Department of Cardiology, National University Heart Centre, Singapore.
authors.forename: Yan Yi
authors.initials: YY
authors.lastname: Cheung
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System.|Department of Cardiology, National University Heart Centre, Singapore.
authors.forename: Chi-Hang
authors.initials: CH
authors.lastname: Lee
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012846:Singapore; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: Berlin questionnaire; general population; obstructive sleep apnea; screening