Utility of the Berlin questionnaire for predicting obstructive sleep apnea in individuals with treatment-resistant depre
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ORIGINAL ARTICLE
Utility of the Berlin questionnaire for predicting obstructive sleep apnea in individuals with treatment-resistant depression Michael W. Best & Michael Fitzpatrick & Roumen Milev & Christopher R. Bowie & Ruzica Jokic
Received: 24 August 2012 / Revised: 11 January 2013 / Accepted: 26 February 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose Obstructive sleep apnea is a disabling sleep disorder characterized by obstructions or near obstructions of the upper airway. Sleep apnea shares many common features with major depressive disorder, which is a serious psychiatric disorder that can persist despite multiple treatment attempts. The current study utilizes baseline data from a study designed to evaluate the effectiveness of continuous positive airway pressure treatment in patients with comorbid treatment-resistant depression and sleep apnea. The aim of this study is to examine the effectiveness of the Berlin questionnaire in predicting which individuals with treatment-resistant depression have obstructive sleep apnea. Methods Eighty-two outpatients with treatment-resistant depression completed the Berlin questionnaire and underwent overnight polysomnography to determine whether they were suffering from undiagnosed obstructive sleep apnea. Results Scoring in the high-risk category on the Berlin questionnaire predicted an apnea/hypopnea index greater than 5 with a sensitivity of 25 % and a specificity of 85.4 %, an apnea/hypopnea index greater than 10 with a M. W. Best : C. R. Bowie Department of Psychology, Queen’s University, Kingston, Canada R. Milev : C. R. Bowie : R. Jokic Department of Psychiatry, Queen’s University, Kingston, Canada M. Fitzpatrick Department of Respiratory and Critical Care, Queen’s University, Kingston, Canada R. Milev : C. R. Bowie Centre for Neuroscience, Queen’s University, Kingston, Canada R. Milev : R. Jokic (*) Mental Health Services, Providence Care, Kingston, Canada e-mail: [email protected]
sensitivity of 24.5 % and a specificity of 91.7 %, and an apnea/hypopnea index greater than 15 with a sensitivity of 22.2 % and a specificity of 92.9 %. The Berlin questionnaire was better at predicting the presence of sleep apnea in our sample of predominantly pre-menopausal women than men, and category 2 of the questionnaire (daytime somnolence) was the poorest predictor of sleep apnea. Conclusions The Berlin questionnaire appears to be a valid instrument for ruling out obstructive sleep apnea in treatment-resistant depression and may be a helpful tool in assisting with the allocation of diagnostic resources. Keywords Berlin questionnaire . Treatment-resistant depression . Obstructive sleep apnea
Introduction Obstructive sleep apnea (OSA) is a dangerous and debilitating condition characterized by repeated apneas (cessation of breathing) and/or hypopneas (partial cessation of breathing) during sleep. Untreated OSA has been associated with hypertension, increased cardiovascular morbidity and mortality, excessive daytime sleepiness, cognitive dysfunction, decr
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