Obstructive Sleep Apnea (OSA)
There are several OSA questionnaires available as screening tools to identify patients at risk for obstructive breathing in sleep. There are three common questionnaires available that vary in the number of questions asked and the time required for medical staff to either administer or analyze the results. It is important to remember that these questionnaires are screening tools only and cannot replace a thorough history and physical or objective sleep laboratory evaluation.
The STOP-BANG questionnaire is an easy-to-use screening tool for patients with moderate to severe OSA, which can be used as a preoperative assessment tool. Less complex than the Berlin questionnaire and more elaborate than the GASP, it includes pertinent questions and other variables such as body mass index, age, neck size, and gender information.
The Berlin questionnaire contains 10 questions covering three categories including 1) snoring severity, 2) excessive daytime sleepiness, and 3) history of high blood pressure or obesity. The patient is instructed to answer questions to all three categories, but the physician or medical staff is needed to analyze the responses. If the individual scores positive in at least 2 of the 3 categories, the patient is found to be at a high risk for obstructive sleep apnea. However, if the patient scores positive in only one or none of the categories, then the patient is deemed to be at a low risk for OSA.
Although the Berlin questionnaire is considered the best studied and validated of the OSA questionnaires, we have found it difficult to get referring physicians to implement this questionnaire because of the need to score the responses with an answer key. Even though the scoring of the responses only takes a nominal amount of time, it can be difficult for some busy primary care offices to implement on a systematic basis. The following pdf file contains the Berlin questionnaire and answer key.
This questionnaire has only three questions for the patient to fill out, but requires a neck circumference measurement by a nurse or medical staff. This questionnaire is easy to administer and analyze. It also is one of the few questionnaires that attempts to stratify risk for obstructive sleep apnea. We have found this questionnaire to be more easily accepted by primary care physicians since it involves less labor and analysis than the Berlin questionnaire. However, there are fewer studies currently available regarding the validation of this questionnaire.
Some of our referring physicians use this questionnaire as a preoperative screening tool to identify patient at risk for OSA prior to surgery. We have made some minor modifications to this questionnaire from its original published version, and we are in the process of validating this questionnaire with our own patient population.
G.A.S.P. – A self administered screening questionnaire
This questionnaire is the most simple of the three, but also one of the least validated. It contains 5 questions assessing the presence of 1) snoring, 2) witnessed apneas, 3) fatigue or sleepiness, 4) hypertension or acid reflux, and 5) being overweight. The patient is scored a 0 for each question if they answer no, and they score a 1 if they answer “yes” or “not sure” for a maximum score of 5. A score of 0-1 is low risk, 2-3 medium risk, and 4-5 high risk for OSA.
Epworth Sleepiness Scale (ESS)