Recognizing Sleep Apnea
By Andrew Senske, President CPAP-Supply.com
Last Updated 11/13/2009 4:50:00 PM


There are two tools that have been widely circulated and used over the course of the last decade to determine if a patient may be suffering from sleep apnea. The Epworth Sleepiness Scale and the Berlin Questionnaire are simple questionnaires focused on the risk factors (like high blood pressure) and chronic behaviors (like excessive loud snoring) that are indicative of the presence of a sleep disorder such as sleep apnea in a patient.

You can use the following questionnaires to identify potential problems with your sleep and to initiate a conversation with your doctor about your sleep-related concerns. I'll discuss each questionnaire briefly, and then you'll have the opportunity to answer the questions yourself. The score for each questionnaire will tell you if you're at higher risk or lower risk for sleep apnea.

If you already know you have sleep apnea but haven't done anything about it, you should start a discussion about diagnosis and treatment with your doctor. Take these questionnaires with you to your next doctor appointment. If you're already experiencing the benefits of CPAP therapy, then I encourage you to share this article with anyone you suspect may be adversely affected by sleep apnea. The questionnaires might give you a feel for whether a family member, friend or acquaintance has sleep apnea or some other sleep disorder. If you know someone who may be at high risk for sleep apnea, but who hasn't been diagnosed with it, then send them a link to this article, and give that person the gift of knowledge.

Berlin Questionnaire
Developed in 1996 at the Conference on Sleep in Primary Care in Berlin, Germany, this 10-question test has since become well-known for its accuracy in predicting the presence of sleep apnea in patients. A study conducted in 1999 by Netzer, Stooh, et. al. determined "that the Berlin Questionnaire will detect important symptom distributions and permit risk grouping in the absence of a physician-patient encounter". The authors of the study also conclude that "the sensitivity of 86% for an RDI (respiratory disturbance index) more than 5 is higher than that of strategies currently used in clinical practice." This means that as of 1999 the study authors believed the Berlin Questionnaire was more effective than typical clinical evaluations being conducted at the time. I suspect that over the last several years the Berlin Questionnaire has become increasingly wide-spread within the medical community and is likely a common strategy in clinical practice today. However, in 1999 this wasn't the case. Even today, it wouldn't surprise me if your primary care physician isn't familiar with the questionnaire, so be sure to bring it up at your next office visit if necessary.

1. Body Mass Index Information:
Height (in inches):
Weight (in pounds):

CATEGORY 1 QUESTIONS
2. Do you snore?
Yes **
No
I don't know

3. How loud is your snoring?
My snoring is as loud as breathing
My snoring is as loud as talking
My snoring is louder than talking **
My snoring is very loud **

4. How frequently do you snore?
Almost every day **
3 - 4 times per week **
1 - 2 times per week
1 - 2 times per month
Never or almost never

5. Does your snoring bother other people?
Yes **
No

6. How often have your breathing pauses been noticed?
Almost every day **
3 - 4 times per week **
1 - 2 times per week
1 - 2 times per month
Never or almost never

CATEGORY 2 QUESTIONS
7. Are you tired after sleeping?
Almost every day **
3 - 4 times per week **
1 - 2 times per week
1 - 2 times per month
Never or almost never

8. Are you tired during waketime?
Almost every day **
3 - 4 times per week **
1 - 2 times per week
1 - 2 times per month
Never or almost never

9. How often do you nod off or fall asleep while driving?
Almost every day **
3 - 4 times per week **
1 - 2 times per week
1 - 2 times per month
Never or almost never

CATEGORY 3 QUESTIONS
10. Do you have high blood pressure?
Yes **
No
I don't know

BMI (body mass index)
BMI > 30 **

Weight
BMI = -------------------- X 703
Height X Height


Weight in pounds, height in inches OR Weight in kilograms, height in meters

Berlin Scoring Results
Any answer followed by double asterisks (**) is a positive response.
Category 1 is positive with 2 or more positive responses to questions 2 through 6
Category 2 is positive with 2 or more positive responses to questions 7 through 9
Category 3 is positive with 1 or more positive responses and/or a BMI>30
2 or more positive categories indicates a high liklihood of sleep apnea

You can view the study showing the effectiveness of the Berlin Questionnaire at the Annals of Internal Medicine website: "Using the Berlin Questionnaire to Identify Patients at Risk for the Sleep Apnea Syndrome".

Epworth Sleepiness Scale
The Epworth Sleepiness Scale is an 8-question questionnaire which is used to determine the level of a person's daytime sleepiness. The Epworth Sleepiness Scale is based on your assessment of the liklihood of you falling asleep in certain situations commonly encountered in daily life. The questionnaire can be used to help diagnose sleep disorders like sleep apnea. The Epworth Sleepiness Scale was developed in 1990 by Murray W. Johns at Epworth Hospital in Melbourne, Australia.

Epworth Sleepines Scale
How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:
0 - No chance of falling asleep
1 - Slight chance of falling asleep
2 - Moderate chance of falling asleep
3 - High chance of falling asleep

Situation Chance of Falling Asleep
Sitting and reading
0123
Watching TV
0123
Sitting inactive in a public place (e.g. a theater or a meeting)
0123
As a passenger in a car for an hour without a break
0123
Lying down to rest in the afternoon as circumstances permit
0123
Sitting and talking to someone
0123
Sitting quietly after lunch without alcohol
0123
In a car while stopped for a few minutes in traffic
0123
Epworth Scoring Results
1 - 6 = Good. You're likely getting restful sleep.
7 - 9 = Okay. You're sleep could be improved, but you may not have sleep apnea.
10 or higher = Bad. You likely have a sleep disorder like sleep apnea.

You can read all about the Epworth Sleepiness Scale at Dr. Murray John's website. The specific article introducing the scale is available on the website at: "A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale"

If either one of these tests show you're at risk for sleep apnea or that you have a tendency to fall asleep during the day, and if your doctor hasn't yet diagnosed you with sleep apnea, then you should talk to your doctor about your condition and about the possibility of starting CPAP therapy.

Andrew Senske
President
www.cpap-supply.com

CPAP-Supply.com is a leading online retailer of CPAP equipment. Located in Spokane, WA CPAP-Supply.com has been serving thousands of customers around the world since 2001. Founded on a belief that patients are their own best primary care providers, CPAP-Supply.com understands the importance of educating patients and customers on both the effects of and treatment for obstructive sleep apnea. For more information visit CPAP-Supply.com or call toll free 1-888-955-2727.