Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients

Chung, Frances; Yegneswaran, Balaji; Liao, Pu; Chung, Sharon A.; Vairavanathan, Santhira; Islam, Sazzadul; Khajehdehi, Ali; Shapiro, Colin M.

doi:10.1097/aln.0b013e31816d91b5

Cited by 645 publications

(630 citation statements)

References 29 publications

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“…While the older type of questionnaire, such as the SA-SDQ, 25 included a greater number of questions that were more complicated, the newer questionnaires, such as STOP and STOP-Bang, have fewer and more straightforward questions. 31,32 The imprecision we detected in the accuracy of these questionnaires as screening tools could have arisen from several factors. One factor could be the methodological quality of the papers, 37 which was poorly reported in the majority of the studies we evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Methodological quality was clearly reported in the studies by Chung et al and Ahmadi 2008. 30-32 Compared with the studies by Ahmadi 2088, 8,30 the studies by Chung et al 31,32 are considered as being even higher quality due to their prospective design and the blind execution of PSG, i.e., the persons responsible for carrying out the standard PSG for the patients were not aware of the results of the questionnaires. Other studies did not address the validation process of the questionnaires, fully evaluate the validity of their results, or, more specifically, eliminate the risk of verification bias.…”

Section: Discussionmentioning

confidence: 99%

“…In an effort to unify the subject populations, all studies were divided into two major groups: studies on patients ''with sleep disorder problems'' 25,27,30,35 and studies on ''patients without known sleep problems''. 28,29,[31][32][33][34] Due to the high prevalence of OSA in patients with sleep disorders, we could not use the first group of studies as a reference for the strength of the questionnaires designed to screen OSA in the general population. Recent evidence shows that a test performance varies in different populations because of the severity of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…30 Overall, the studies by Chung et al on the STOP and STOP-Bang questionnaires had the highest internal validity. 31,32 In terms of the external validity (generalizability), most of the studies met the appraisal items adequately (Table 5). In Sharma 2006a, a pre-screening set of questions was used to select the subjects out of the general population; 33 therefore, this study is missing one of the important components of the external validity and is at risk of screening bias, i.e., those who were selected for the validation of the screening questionnaire already had some type of sleeprelated problems, and they do not necessarily represent the target population of the study.…”

Section: Methodological Quality Of the Included Studiesmentioning

confidence: 99%

“…28 Only three studies adequately addressed the validation process of the questionnaires (Chung 2008a, Chung 2008b, and Ahmadi 2008). [30][31][32] The other included studies did not have specific information to clearly evaluate the risk of bias during the validation process of their questionnaires. More specifically, the following aspects were not specified in the papers: 1) blind execution of the PSG and questionnaire, i.e., those who performed the PSG were unaware of the results of the questionnaire (and vice versa); 2) avoidance of verification bias, i.e., interpretation of the PSG results was performed independent of the questionnaire results; and 3) interpretation of the PSG results was performed independent from the patient's clinical history.…”

Section: Methodological Quality Of the Included Studiesmentioning

confidence: 99%

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A systematic review of screening questionnaires for obstructive sleep apnea

Abrishami

Khajehdehi

Chung

2010

Can J Anesth/J Can Anesth

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490

341

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Purpose Obstructive sleep apnea (OSA) may lead to lifethreatening problems if it is left undiagnosed. Polysomnography is the ''gold standard'' for OSA diagnosis; however, it is expensive and not widely available. The objective of this systematic review is to identify and evaluate the available questionnaires for screening OSA. Source We carried out a literature search through MEDLINE, EMBASE, and CINAHL to identify eligible studies. The methodological validity of each study was assessed using the Cochrane Methods Group's guideline. Principal findings Ten studies (n = 1,484 patients) met the inclusion criteria. The Berlin questionnaire was the most common questionnaire (four studies) followed by the Wisconsin sleep questionnaire (two studies). Four studies were conducted exclusively on ''sleep-disorder patients'', and six studies were conducted on ''patients without history of sleep disorders''. For the first group, pooled sensitivity was 72.0% (95% confidence interval [CI]: 66.0-78.0%; I 2 = 23.0%) and pooled specificity was 61.0% (95% CI: 55.0-67.0%; I 2 = 43.8%). For the second group, pooled sensitivity was 77.0% (95% CI: 73.0-80.0%; I 2 = 78.1%) and pooled specificity was 53.0% (95% CI: 50-57%; I 2 = 88.8%). The risk of verification bias could not be eliminated in eight studies due to insufficient reporting. Studies on snoring, tiredness, observed apnea, and high blood pressure (STOP) and STOP including body mass index, age, neck circumference, gender (Bang) questionnaires had the highest methodological quality. ConclusionThe existing evidence regarding the accuracy of OSA questionnaires is associated with promising but inconsistent results. This inconsistency could be due to studies with heterogeneous design (population, questionnaire type, validity). STOP and STOP-Bang questionnaires for screening of OSA in the surgical population are suggested due to their higher methodological quality and easyto-use features. RésuméObjectif L'apne´e obstructive du sommeil (AOS) peut provoquer des proble`mes de sante´fatals si elle n'est pas diagnostique´e. La polysomnographie est «l'e´talon or» du diagnostic de l'AOS; cependant, cette me´thode est one´reuse et n'est pas disponible partout. L

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodological Quality Of the Included Studiesmentioning

confidence: 99%

Section: Methodological Quality Of the Included Studiesmentioning

confidence: 99%

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A systematic review of screening questionnaires for obstructive sleep apnea

Abrishami

Khajehdehi

Chung

2010

Can J Anesth/J Can Anesth

Self Cite

490

341

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Diagnosis and Management of Obstructive Sleep Apnea

Gottlieb

Punjabi

2020

JAMA

846

580

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ImportanceObstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. This review provides an update on the diagnosis and treatment of OSA.ObservationsThe most common presenting symptom of OSA is excessive sleepiness, although this symptom is reported by as few as 15% to 50% of people with OSA in the general population. OSA is associated with a 2- to 3-fold increased risk of cardiovascular and metabolic disease. In many patients, OSA can be diagnosed with home sleep apnea testing, which has a sensitivity of approximately 80%. Effective treatments include weight loss and exercise, positive airway pressure, oral appliances that hold the jaw forward during sleep, and surgical modification of the pharyngeal soft tissues or facial skeleton to enlarge the upper airway. Hypoglossal nerve stimulation is effective in select patients with a body mass index less than 32. There are currently no effective pharmacological therapies. Treatment with positive airway pressure lowers blood pressure, especially in patients with resistant hypertension; however, randomized clinical trials of OSA treatment have not demonstrated significant benefit on rates of cardiovascular or cerebrovascular events.Conclusions and RelevanceOSA is common and the prevalence is increasing with the increased prevalence of obesity. Daytime sleepiness is among the most common symptoms, but many patients with OSA are asymptomatic. Patients with OSA who are asymptomatic, or whose symptoms are minimally bothersome and pose no apparent risk to driving safety, can be treated with behavioral measures, such as weight loss and exercise. Interventions such as positive airway pressure are recommended for those with excessive sleepiness and resistant hypertension. Managing asymptomatic OSA to reduce cardiovascular and cerebrovascular events is not currently supported by high-quality evidence.

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Screening for Obstructive Sleep Apnea in Adults

Jonas¹,

Amick²,

Feltner³

et al. 2022

JAMA

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ImportanceObstructive sleep apnea (OSA) is associated with adverse health outcomes.ObjectiveTo review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force.Data SourcesPubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022.Study SelectionEnglish-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores.Data Extraction and SynthesisDual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials.Main Outcomes and MeasuresTest accuracy, excessive daytime sleepiness, sleep-related and general health–related quality of life (QOL), and harms.ResultsEighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score &gt;10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, −2.33 [95% CI, −2.75 to −1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health–related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, −1.67 [95% CI, 2.09 to −1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg).Conclusions and RelevanceThe accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health–related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.

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Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients

Abstract: Similar to the STOP questionnaire, the Berlin questionnaire and ASA checklist demonstrated a moderately high level of sensitivity for OSA screening. The STOP questionnaire and the ASA checklist were able to identify the patients who were likely to develop postoperative complications.

Cited by 645 publications

References 29 publications

A systematic review of screening questionnaires for obstructive sleep apnea

A systematic review of screening questionnaires for obstructive sleep apnea

Diagnosis and Management of Obstructive Sleep Apnea

Screening for Obstructive Sleep Apnea in Adults

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