Is the Berlin questionnaire a useful tool to diagnose obstructive sleep apnea in the elderly?

In the elderly, obstructive sleep apnea (OSA) is frequently under diagnosed. This study was undertaken to assess the accuracy of the Berlin questionnaire to diagnose OSA in a large healthy elderly population.

Six hundred forty-three participants aged 65.6 years were examined. All subjects completed the Berlin questionnaire and underwent at-home respiratory recording. Presence of OSA was defined by an AHI>15.

Of the respondents, 202 subjects (31.4%) were in an OSA high-risk group according to the Berlin questionnaire. The high-risk subjects were significantly heavier, had greater waist and hip circumferences, higher AHI, and reported more frequently hypertension and diabetes. Habitual snoring was present in 54% of the sample, sleepiness in 12% of participants, and a BMI>30 and a history of hypertension in 42.1%. Being in the high-risk group predicted an AHI>15 with a sensitivity of 77%, a specificity of 39%, a positive predictive value of 63% and a negative predictive value of 55%. Among Berlin questionnaire categories, snoring correctly classified 61% of the sample and explained the 5% variance of AHI.

The Berlin questionnaire did not provide a high level of diagnostic specificity to discriminate OSA in an elderly population. Although not sufficiently accurate, this questionnaire can be used to identify subjects for sleep study assessment.