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Accuracy of the Epworth Sleepiness Scale and Berlin Questionnaire for the Diagnosis of Obstructive Sleep Apnea in a Specialized Service.
Type 1 polysomnography is the gold standard method for diagnosing sleep apnea hypopnea syndrome (OSAHS). However, access to this test is limited. Thus, screening tools were proposed, including the Berlin questionnaire and the Epworth sleepiness scale (ESS).
To perform the sensitivity, specificity, positive predictive value and negative predictive value of the Epworth Sleepiness Scale and the Berlin Questionnaire in a sample of patients who underwent type 3 polysomnography.
From January 2017 to August 2021, 561 adult patients who are under outpatient follow-up in a pulmonology service in Porto Alegre-RS underwent type 3 polysomnography. Of these, 552 had the Epworth sleepiness scale and the Berlin questionnaire completed. It was correlated, through the chi-square test, with the diagnosis of OSAHS, defined by an apnea hypopnea Index (AHI) above 5.
Of the 552 patients, 309 (56%) had a positive Epworth sleepiness scale (above 10 points), of which 58 (18.8%) had an AHI below 5 and 251 (81.2%) were diagnosed with OSAHS through the method. Of the remaining 243 patients (44%) in which the Epworth sleepiness scale was negative, 80 (32.9%) were not diagnosed with OSAHS, but 163 (67.1%) had the index above 5 points. Thus, the sensitivity of the Epworth sleepiness scale was 60.6%, specificity 58%, positive predictive value of 81.2% and negative predictive value 32.9% (p-value 0.000). Regarding the Berlin questionnaire, 461 patients (82%) were at high risk for presenting OSAHS (positive in 2 or more categories), and of these, 373 (80.9%) were indeed diagnosed with OSAHS and 88 (19.1%) had an AHI below 5. Among the 91 patients at low risk for OSAHS according to the Berlin questionnaire, 50 (54.9%) had an AHI below 5 and 41 patients (45.1%) were diagnosed with OSAHS. Thus, the sensitivity of this test is 90.1%, specificity 36.2%, positive predictive value 80.9% and negative predictive value 54.9% (p-value 0.00).
This work presents similar results to those described in the literature on the sensitivity and specificity of the Berlin questionnaire and Epworth sleepiness scale tools. It corroborates with the American Academy of Sleep Medicine (AASM) that these questionnaires should not be used routinely in asymptomatic patients, recommending contextualizing their use within a clinical setting suggestive of apnea.
1. Berlin questionnaire. 2. Epworth sleepiness scale. 3. Accuracy. 4. Sleep apnea hypopnea syndrome.
IRMANDADE SANTA CASA DE MISERICÓRDIA DE PORTO ALEGRE - Rio Grande do Sul - Brasil, UNIVERSIDADE DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE - Rio Grande do Sul - Brasil
Ronaldo Cesar Barros Pinto, Joana lunardi, Aline Tiemi Hirose Ventura, Fernanda Altmann Oliveira, Carlos Javier Mendoza Bravo, Fabíola Schorr, Eduardo Garcia