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Original Research: SLEEP DISORDERS |

Diagnostic Accuracy of the Berlin Questionnaire in Detecting Sleep-Disordered Breathing in Patients With a Recent Myocardial InfarctionScreening for Sleep-Disordered Breathing

Fatima H. Sert Kuniyoshi, PhD; Mark R. Zellmer, PhD; Andrew D. Calvin, MD, MPH; Francisco Lopez-Jimenez, MD; Felipe N. Albuquerque, MD; Christelle van der Walt, RPSGT; Ivani C Trombetta, PhD; Sean M. Caples, DO; Abu S. Shamsuzzaman, PhD; Jan Bukartyk, MSc; Tomas Konecny, MD; Apoor S. Gami, MD; Tomas Kara, MD, PhD; Virend K. Somers, MD, PhD, FCCP
Author and Funding Information

From the Division of Cardiovascular Diseases (Drs Sert Kuniyoshi, Zellmer, Calvin, Lopez-Jimenez, Albuquerque, Trombetta, Shamsuzzaman, Konecny, Gami, Kara, and Somers; Mr Bukartyk; and Ms van der Walt) and Division of Pulmonary and Critical Care Medicine (Dr Caples), Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN; and ICRC-Department of Cardiovascular Diseases (Dr Kara), St. Anne’s University Hospital Brno, Brno, Czech Republic.

Correspondence to: Virend K. Somers, MD, PhD, FCCP, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; e-mail: somers.virend@mayo.edu


Funding/Support: Dr Sert Kuniyoshi was supported by the American Heart Association [Grant 09-20069G]. Dr Calvin is supported by the Mayo Clinic Clinician-Investigator Training Program. Dr Somers is supported by National Institutes of Health (NIH) [Grants HL65176 and 1 UL1 RR024150]. Dr Caples is supported by NIH [Grant HL09953]. Dr Kara is supported by grants of IGA of Ministry of Health [Grants NS 10098-4/2008] and by European Regional Development Fund, Project FNUSA-ICRC [Grant CZ.1.05/1.1.00/02.0123]. These studies also were supported by a gift to Mayo Foundation by the Respironics Foundation for Sleep and Breathing.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1192-1197. doi:10.1378/chest.10-2625
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Background:  The Berlin Questionnaire (BQ) has been used to identify patients at high risk for sleep-disordered breathing (SDB) in a variety of populations. However, there are no data regarding the validity of the BQ in detecting the presence of SDB in patients after myocardial infarction (MI). The aim of this study was to determine the performance of the BQ in patients after MI.

Methods:  We conducted a cross-sectional study of 99 patients who had an MI 1 to 3 months previously. The BQ was administered, scored using the published methods, and followed by completed overnight polysomnography as the “gold standard.” SDB was defined as an apnea-hypopnea index of ≥ 5 events/h. The sensitivity, specificity, and positive and negative predictive values of the BQ were calculated.

Results:  Of the 99 patients, the BQ identified 64 (65%) as being at high-risk for having SDB. Overnight polysomnography showed that 73 (73%) had SDB. The BQ sensitivity and specificity was 0.68 and 0.34, respectively, with a positive predictive value of 0.68 and a negative predictive value of 0.50. Positive and negative likelihood ratios were 1.27 and 0.68, respectively, and the BQ overall diagnostic accuracy was 63%. Using different apnea-hypopnea index cutoff values did not meaningfully alter these results.

Conclusion:  The BQ performed with modest sensitivity, but the specificity was poor, suggesting that the BQ is not ideal in identifying SDB in patients with a recent MI.


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