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Volume 13 No. 03
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Accepted Papers

Scientific Investigations

Using the Berlin Questionnaire to Predict Obstructive Sleep Apnea in the General Population

Adeline Tan, MBBS1; Jason D.C. Yin, MSc2; Linda W.L. Tan, MPH2; Rob M. van Dam, PhD2,3; Yan Yi Cheung, BSc3,4; Chi-Hang Lee, MD3,4
1Department of Respiratory Medicine, Ng Teng Fong General Hospital, Jurong Health Services, Singapore; 2Saw Swee Hock School of Public Health, National University of Singapore and National University Health System; 3Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System; 4Department of Cardiology, National University Heart Centre, Singapore.

Study Objectives:

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.


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.


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.


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.


Tan A, Yin JD, Tan LW, van Dam RM, Cheung YY, Lee CH. Using the Berlin questionnaire to predict obstructive sleep apnea in the general population. J Clin Sleep Med. 2017;13(3):427–432.

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