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The Berlin Questionnaire Screens for Obstructive Sleep Apnea in Idiopathic Intracranial Hypertension

Thurtell, Matthew J. MBBS, FRACP; Bruce, Beau B. MD; Rye, David B. MD; Newman, Nancy J. MD; Biousse, Valerie MD

doi: 10.1097/WNO.0b013e31821a4d54
Original Contribution

Background Obstructive sleep apnea (OSA) may be associated with idiopathic intracranial hypertension (IIH), a disorder most commonly occurring in young obese women. Because polysomnography, the standard test for diagnosing OSA, is expensive and time consuming, questionnaires have been developed to identify persons with OSA. The Berlin questionnaire (BQ) reliably identifies middle-aged and older persons in the community who are at high-risk for OSA. We aimed to validate the BQ as a screening tool for OSA in IIH patients.

Methods Patients with newly diagnosed IIH completed the BQ and then underwent diagnostic polysomnography. The BQ was scored as high or low risk for OSA, and the diagnosis of OSA was based on polysomnography findings. OSA was defined as an apnea-hypopnea index of ≥5 on polysomnography.

Results Thirty patients were evaluated (24 women; 15 white and 15 black; age, 16–54 years [median, 32 years]; body mass index, 27.3–51.7 kg/m2 [median, 39.8 kg/m2]). Twenty patients (66.7%) had a high-risk BQ score and 18 (60%) exhibited OSA. Fifteen of 20 (75%) with a high-risk BQ score had OSA, while 3 of 10 (30%) with a low-risk score had OSA (Fisher test, P = 0.045). The sensitivity and specificity of the BQ for OSA in IIH patients were 83% and 58%, respectively, whereas the positive predictive value was 75%.

Conclusion A low-risk BQ score identifies IIH patients who are unlikely to have OSA. Polysomnography should be considered in those with a high-risk score.

Department of Ophthalmology and Visual Sciences (MJT), The University of Iowa, Iowa City, Iowa; Emory Eye Center, Emory University School of Medicine (BBB, NJN, VB), Atlanta, Georgia; and Department of Neuroscience (DBR), Emory University, Atlanta, Georgia.

Supported in part by a departmental grant (Department of Ophthalmology) from the Research to Prevent Blindness, Inc, New York, NY, by core grant P30-EY06360. Dr Bruce received research support from the National Institutes of Health/Public Health Service (KL2-RR025009, UL1-RR025008), National Institutes of Health/National Eye Institute (K23-EY019341), and the Knights Templar Eye Foundation and also the American Academy of Neurology Practice Research Fellowship. Dr Biousse received research support from National Institutes of Health/Public Health Service (UL1-RR025008). Dr Newman is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award. Dr Rye received research support from the NIH/USPHS (NS055015 and MH083746) and is a consultant for the USPHS, Merck Co, Inc, and UCB Inc.

The authors report no conflicts of interest.

Address correspondence to Valerie Biousse, MD, Neuro-Ophthalmology Unit, Emory Eye Center, 1365-B Clifton Road NE, Atlanta, GA 30322; E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.