Madhavan C et al / International Journal of Biomedical Research 2016; 7(3): 122-124. 122 IJBR (2016) 7 (03) www.ssjournals.com International Journal of Biomedical Research ISSN: 0976-9633 (Online); 2455-0566 (Print) Journal DOI: 10.7439/ijbr CODEN: IJBRFA Original Research Article The Berlin Questionnaire is a more sensitive tool than the Epworth Sleepiness Scale for screening Obstructive Sleep Apnea Madhavan C 1 , Das S *1 , Suganthi B 1 and Kisku KH 2 1 Department of Physiology, Pondicherry Institute of Medical Sciences, Kalathumettupathai, Ganapathichettikulam, Village No.20, Kalapet, Puducherry, Pondicherry, India - 605 014 2 Department of Pulmonology, Pondicherry Institute of Medical Sciences, Kalathumettupathai, Ganapathichettikulam, Village No.20, Kalapet, Puducherry, Pondicherry, India - 605 014 *Correspondence Info: Dr. Subhasis Das, Department of Physiology, Pondicherry Institute of Medical Sciences, Kalathumettupathai, Ganapathichettikulam, Village No.20, Kalapet, Puducherry, Pondicherry, India - 605 014 E-mail: subhasiscmc@gmail.com Abstract Background: Obstructive sleep apnea syndrome (OSAS) remains a highly under-diagnosed clinical entity since many clinicians use sleep questionnaires for diagnosis, instead of the gold standard, albeit expensive test, polysomnography. This study compared the efficacy of two such questionnaires in diagnosing OSAS. Material and methods: The Epworth Sleepiness Scale (ESS) was compared with Berlin Questionnaire (BQ) in this study. Patients with sleep disordered breathing were asked to fill up both ESS and BQ. Subsequently they underwent Level 1 polysomnography. The Apnea Hypopnea Index (AHI) thus obtained was used to compare the ESS and BQ for their sensitivity in screening for OSA. Result: Out of a total of 55 patients, 34 true positives were detected by ESS and 46 by BQ (68% and 92% sensitivity respectively). Conclusion: It was found that BQ was a tool with greater sensitivity than ESS in screening for OSA in the Indian population. Keywords: OSAS, Epworth Sleepiness Scale, Berlin Questionnaire. 1. Introduction Obstructive sleep apnea syndrome (OSAS) is defined as the repetitive occurrence of complete or partial obstruction of the upper airway during sleep.[1] It is prevalent in 1-4% of middle aged males and is about half as common in women.[2] Chronic untreated OSAS is associated with sleep and cognitive disturbances and increased daytime sleepiness. These effects are reflected as decreased work performance [3], increased accidents [4] and diminished quality of life [5,6] and are mainly attributed to the fragmented sleep and nocturnal hypoxemia. The gold standard for diagnosing OSAS is to perform a Level 1 polysomnography (PSG) which includes recording the respiratory and other neurophysiologic signals during sleep. In many countries the PSG is limited by recording only the respiratory events and oxygen saturation which has proven to be cost effective.[2] In many centres without the facility to perform PSG the diagnosis is dependent on obtaining a detailed sleep history from the patient and the partner by using sleep questionnaires like the Epworth Sleepiness Scale and physical examination to eliminate differential diagnoses of OSAS, like obesity, hypothyroidism, hypertension, cranio-facial deformity etc. The Epworth Sleepiness Scale (ESS) as the name suggests is designed to evaluate excessive daytime sleepiness by making the subject score the probability of drifting to sleep on a scale of 0-3, with 3 implying very high chance of dosing and 0 for absolutely no chance of dosing, in 8 different hypothetical situations during the day. A score of ≥10 is considered to be excessively sleepy during the day and the person is advised to seek medical attention.[7] ESS is the most widely used sleep assessing tool in clinics and in most sleep labs. But ESS has its own disadvantages. It is not etiology specific, and is just an indicator of excessive day time sleepiness. Also, this scale is entirely dependent on the patient's history, which may be subjective, and no objective parameters are taken into consideration for diagnosis. In view of these shortcomings of the ESS, search for a more suitable tool to diagnose sleep disordered breathing like OSAS is called for.