Difference between revisions of "Berlin Questionnaire"
Walla Walla (talk | contribs) |
Walla Walla (talk | contribs) |
(No difference)
| |
Latest revision as of 22:35, 16 March 2018
The Berlin questionnaire is a simple screening tool used by physicians to screen for Sleep Apnea. It was developed in Berlin, Germany by a group of Doctors in 1998.
Normally the patient is asked to fill out the questionnaire by either their Family Doctor or the Sleep Center prior to a Polysomnogram being scheduled.
There are normally 10 questions covering Snoring, Fatigue, and High Blood Pressure. Also height and weight are asked. Each question is scored to give an overall risk rating.
Berlin Questionnaire Form
Height (m) _______
Weight (kg)_______
Age _______
Male/Female
Category 1
1. Do you snore?
a. Yes
b. No
c. Don't know
2. Your snoring is:
a. Slightly louder than breathing
b. As loud as talking
c. Louder than talking
3. How often do you snore?
a. Almost every day
b. 3-4 times per week
c. 1-2 times per week
d. 1-2 times per month
e. Rarely or never
4. Has your snoring ever bothered
other people?
a. Yes
b. No
c. Don't know
5. Has anyone noticed that you stop breathing
during your sleep?
a. Almost every day
b. 2-4 times per week
c. 1-2 times per week
d. 1-2 times per month
e. Rarely or never
Category 2
6. How often do you feel tired or fatigued after you sleep?
a. Almost every day
b. 3-4 times per day
c. 1-2 times per day
d. 1-2 times per month
e. Rarely or never
7. During your waking time, do you feel tired, fatigued
or not not up to par?
a. Almost every day
b. 3-4 times per week
c. 1-2 times per week
d. 1-2 times per month
e. Rarely or never
8. Have you ever nodded off or fallen asleep while driving
a vehicle?
a. Yes b. No
If you answered "yes"
9. How often does this occur?
a. Almost every day
b. 3-4 times per week
c. 1-2 times per week
d. 1-2 times per month
e. Rarely or never
Category 3:
10. Do you have high blood pressure?
a. Yes
b. No
c. Don't know
Scoring the Questionnaire is as follows:
Category 1:
items 1, 2, 3, 4, and 5
Item1: If Yes selected, assign 1 point
Item 2: if c or d selected, assign 1 point
Item 3: if a or b selected, assign 1 point
Item 4: if a selected, assign 1 point
Item 5: if a or b selected, assign 2 points
Add points. Category 1 is positive if total score is 2 or more points.
Category 2:
items 6, 7, 8 (item 9 should be noted separately).
item 6: if a or b selected, assign 1 point
item 7: if a or b selected, assign 1 point
item 8: if a is selected, assign 1 point
Add points. Category 2 is positive if the total score is 2 or more points.
Category 3: is positive if the answer to item 10 is Yes or if the BMI of the patient is greater than 30(kg)/m2).
(BMI is defined as weight (kg) divided by height (m) squared).
Or if your math dumb like me, you can search the internet for a BMI chart.
High Risk: if there are 2 or more categories where the score is positive.
Low Risk: if there is only 1 or no categories where the score is positive.
Additional Question: item 9 should be noted separately.
Donate to Apnea Board
