The Berlin Questionnaire in pregnancy predominantly identifies obesity

Obstructive sleep apnea (OSA) is common in pregnant women and is a risk factor for poor perinatal outcomes. The Berlin Questionnaire (BQ) is a validated OSA screening tool that is often used in pregnancy. However, its poor performance in this population is likely attributed to the scoring paradigm that primarily identifies obesity. Moreover, the associations between the BQ and pregnancy outcomes are often those same outcomes that are obesity related. Therefore, this study examined associations between each of the 3 BQ domains, independently and jointly, in relation to gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP).

Pregnant third-trimester women were recruited from a tertiary medical center and completed the BQ, which includes 3 independent domains: snoring, sleepiness, and obesity/high blood pressure. Medical records were accessed for diagnoses of GDM and HDP.

Of the 1,588 pregnant women, 44% had a positive BQ score. Women with a positive score for domains of snoring exclusively, sleepiness exclusively, or their combination did not have an increased risk for GDM or HDP. However, women without snoring or sleepiness, but with a positive score on the body mass index/blood pressure domain had increased odds of GDM (odds ratio 2.0, 95% confidence interval 1.3-3.3) and HDP (odds ratio 2.9, 95% confidence interval 1.6-5.5). Furthermore, any positive score in domain combinations that included body mass index/blood pressure had increased odds of GDM and HDP compared with negative scores in all domains. In addition, in the presence of obesity without hypertension, snoring, or sleepiness, the odds of GDM and HDP were similarly increased.

The poor performance of the BQ in screening for OSA risk may be attributed to its predominant reliance on identification of obesity.

O'Brien LM, Levine RS, Dunietz GL. The Berlin Questionnaire in pregnancy predominantly identifies obesity. J Clin Sleep Med. 2021;17(8):1553-1561.