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Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome

Nikolaus C. Netzer, MD; Riccardo A. Stoohs, MD; Cordula M. Netzer; Kathryn Clark; and Kingman P. Strohl, MD
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From Center for Sleep Education and Research, Case Western Reserve University, Cleveland, Ohio; and Sleep Disorders Research Center, Stanford University, Palo Alto, California.


Acknowledgments: The authors thank the physicians participating in this study: Drs. Douglas Flagg, Charles Pavluk, Timothy Reed, David Rosenberg, John Thomas, and Michael Nochomovitz. Dr. Bruce Wilkenfeld provided surveys of practice demographics. They also thank Dr. Susan Redline for her strategic advice and encouragement, Chris Burant for help with the statistical models, and Dr. Amy Justice for review of the manuscript.

Grant Support: The Cleveland study was supported in part by Mallinckrodt (formerly Nellcor Puritan Bennett); 3M, Inc.; the Brendan Schmittman Foundation (Cologne, Germany); the University Primary Care Practice (Cleveland, Ohio); the National Institutes of Health (grants HL-03650 and HL-42215) and the Department of Veterans Affairs Medical Service.

Requests for Reprints: Kingman P. Strohl, MD, Case Western Reserve University, 10701 East Boulevard, Cleveland, OH 44106. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Netzer and Ms. Netzer: Universitätsklinikum Ulm, Steinhovelstrasse 9, 89071 Ulm, Germany.

Dr. Stoohs: Sleep Disorders Clinic, Stanford University, 701 Welch Road, Palo Alto, CA 94304.

Ms. Clark and Dr. Strohl: Case Western Reserve University, 10701 East Boulevard, Cleveland, OH 44106.


Ann Intern Med. 1999;131(7):485-491. doi:10.7326/0003-4819-131-7-199910050-00002
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The obstructive sleep apnea-hypopnea syndrome is a potentially disabling condition characterized by excessive daytime sleepiness, disruptive snoring, repeated episodes of upper airway obstruction during sleep, and nocturnal hypoxemia. Epidemiologic surveys indicate associations among snoring, sleep apnea, and cardiovascular disease (1). A 1993 population-based study (2) of workers in Wisconsin found that 2% of women and 4% of men had symptoms of sleepiness with associated levels of sleep apnea believed to indicate at least a moderate degree of illness. Prevalence estimates from other countries and other U.S. studies are similar (35). Recognition of sleep apnea by community physicians is, however, low. In the Wisconsin study (6), only 7% of women and 12% of men who had moderate to severe illness reported receiving a diagnosis of sleep apnea from a medical encounter.

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Figure.
The respiratory disturbance index in a subset (13%) of 744 respondents.nsolid linendashed lineP

The cumulative distribution of the respiratory disturbance index for patients at high risk ( = 69; ) and those at lower risk ( = 31; ) for sleep apnea is shown. The groups differed significantly ( < 0.001).

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Summary for Patients

Using a Questionnaire to Help Identify Patients with Sleep Apnea

The summary below is from the full report titled “Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome.” It is in the 5 October 1999 issue of Annals of Internal Medicine (volume 131, pages 485-491). The authors are N.C. Netzer, R.A. Stoohs, C.M. Netzer, K. Clark, and K.P. Strohl.

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