IJMABHR International Journal of Medical and All Body Health ResearchIJMABHR 2582-8940 Anfo Publication House 420 10.54660/IJMBHR.2026.7.1.24-33 Comparative Evaluation of the Berlin Questionnaire and Epworth Sleepiness Scale for Screening Obstructive Sleep Apnea: A Polysomnography-Based Study SolankiSagar RedhuSumit AnashMohd SahaySanjay SainiRajinder Rama Medical College Hospital, Hapur, Uttar Pradesh, India 2026 7 1 24 33 28102025 29112025 CC BY-NC-SA 4.0

Background: Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed sleep-related breathing disorder with significant cardiovascular and metabolic consequences. Screening questionnaires offer accessible preliminary assessment tools, but their diagnostic accuracy requires validation against polysomnography (PSG). Objective: To evaluate and compare the diagnostic performance of the Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS) in screening for OSA, using PSG as the gold standard. Methods: This cross-sectional observational study was conducted at a tertiary sleep disorders center over 18 months. A total of 248 adult participants with suspected OSA underwent comprehensive evaluation using BQ and ESS, followed by overnight laboratory-based PSG. OSA severity was classified based on Apnea-Hypopnea Index (AHI): mild (5-14.9 events/hour), moderate (15-29.9 events/hour), and severe (≥30 events/hour). Diagnostic accuracy parameters including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both screening tools. Results: Among 248 participants (mean age 46.3±12.7 years, 64.5% male), PSG confirmed OSA in 182 (73.4%) subjects. The Berlin Questionnaire demonstrated sensitivity of 78.6%, specificity of 65.2%, PPV of 83.7%, and NPV of 56.8% for detecting OSA (AHI ≥5). The ESS showed sensitivity of 54.4%, specificity of 75.8%, PPV of 82.5%, and NPV of 44.6%. BQ exhibited superior sensitivity (p=0.001), while ESS showed higher specificity (p=0.042). Both tools demonstrated reduced sensitivity in mild OSA cases compared to moderate-to-severe disease. Conclusion: The Berlin Questionnaire demonstrates superior sensitivity for OSA screening, making it more suitable for initial case identification. The ESS, with higher specificity, may better complement clinical evaluation. Combined utilization of both instruments may optimize screening effectiveness, though neither tool can replace polysomnography for definitive diagnosis.  

 Obstructive Sleep ApneaBerlin QuestionnaireEpworth Sleepiness ScalePolysomnographyScreeningSensitivitySpecificityApnea-Hypopnea IndexSleep DisordersDiagnostic Accuracy References Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687-98. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291(16):2013-6. Kapur V, Strohl KP, Redline S, Iber C, O'Connor G, Nieto J. Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath. 2002;6(2):49-54. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046-53. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034-41. Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O'Connor GT, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6(8):e1000132. Streatfeild J, Smith J, Mansfield D, Pezzullo L, Hillman D. The social and economic cost of sleep disorders. Sleep. 2021;44(11):zsab132. International Journal of Medical and All Body Health Research www.allmedicaljournal.com Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499-521. Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med. 2004;169(6):668-72. Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth. 2010;57(5):423-38. Ramachandran SK, Josephs LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology. 2009;110(4):928-39. Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, et al. Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev. 2017;36:57-70. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485-91. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108(5):822-30. Sforza E, Chouchou F, Pichot V, Herrmann F, Barthélémy JC, Roche F. Is the Berlin Questionnaire a useful tool to diagnose obstructive sleep apnea in the elderly? Sleep Med. 2011;12(2):142-6. 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):427-32. Ahmadi N, Chung SA, Gibbs A, Shapiro CM. The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath. 2008;12(1):39-45. Chai-Coetzer CL, Antic NA, Rowland LS, Reed RL, Esterman A, Catcheside PG, et al. Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life: a randomized trial. JAMA. 2013;309(10):997-1004. Pang KP, Terris DJ. Screening for obstructive sleep apnea: an evidence-based analysis. Am J Otolaryngol. 2006;27(2):112-8. Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med. 2007;3(7):737-47. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med. 2012;8(5):597-619. Kunisaki KM, Brown KE, Fabbrini AE, Wetherbee EE, Rector TS. Validation of the Berlin Questionnaire in a sleep clinic population. Sleep Breath. 2011;15(4):825-37. Sharma SK, Vasudev C, Sinha S, Banga A, Pandey RM, Handa KK. Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome. Indian J Med Res. 2006;124(3):281-90. Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructive sleep apnea?: The Rational Clinical Examination systematic review. JAMA. 2013;310(7):731-41. Gottlieb DJ, Whitney CW, Bonekat WH, Iber C, James GD, Lebowitz M, et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med. 1999;159(2):502-7. Baldwin CM, Griffith KA, Nieto FJ, O'Connor GT, Walsleben JA, Redline S. The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep. 2001;24(1):96-105. Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest. 2000;118(2):372-9. Gottlieb DJ, Hek K, Chen TH, Watson NF, Eiriksdottir G, Byrne EM, et al. Novel loci associated with usual sleep duration: the CHARGE Consortium Genome-Wide Association Study. Mol Psychiatry. 2015;20(10):1232-9. Benbadis SR, Mascha E, Perry MC, Wolgamuth BR, Smolley LA, Dinner DS. Association between the Epworth sleepiness scale and the multiple sleep latency test in a clinical population. Ann Intern Med. 1999;130(4 Pt 1):289-92. Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med. 1994;150(5 Pt 1):1279-85. Rowley JA, Aboussouan LS, Badr MS. The use of clinical prediction formulas in the evaluation of obstructive sleep apnea. Sleep. 2000;23(7):929-38. Maislin G, Pack AI, Kribbs NB, Smith PL, Schwartz AR, Kline LR, et al. A survey screen for prediction of apnea. Sleep. 1995;18(3):158-66. Vana KD, Silva GE, Goldberg R. Predictive abilities of the STOP-Bang and Epworth Sleepiness Scale in identifying sleep clinic patients at high risk for obstructive sleep apnea. Res Nurs Health. 2013;36(1):84-94. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab. 2005;90(8):4510-5. Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993;147(4):887-95. Chai-Coetzer CL, Antic NA, Hamilton GS, McArdle N, Wong K, Yee BJ, et al. Physician decision making and clinical outcomes with laboratory polysomnography or limited-channel sleep studies for obstructive sleep apnea: a randomized trial. Ann Intern Med. 2017;166(5):332-40. International Journal of Medical and All Body Health Research www.allmedicaljournal.com Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev. 2017;34:70-81. Masa JF, Corral J, Pereira R, Duran-Cantolla J, Cabello M, Hernández-Blasco L, et al. Effectiveness of sequential automatic-manual home respiratory polygraphy scoring. Eur Respir J. 2013;41(4):879-87. Kendzerska T, Gershon AS, Hawker G, Leung RS, Tomlinson G. Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study. PLoS Med. 2014;11(2):e1001599. Rosenthal LD, Dolan DC. The Epworth sleepiness scale in the identification of obstructive sleep apnea. J Nerv Ment Dis. 2008;196(5):429-31. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479-504. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2019;15(2):301-34. Lim DC, Pack AI. Obstructive sleep apnea: update and future. Annu Rev Med. 2017;68:99-112.