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Sleep Breath. 2013 Mar;17(1):381-8. doi: 10.1007/s11325-012-0705-3. Epub 2012 Apr 26.

Occupational screening for sleep disorders in 12-h shift nurses using the Berlin Questionnaire.

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University of Maryland School of Nursing, Baltimore, MD 21201, USA.



The Berlin Questionnaire has been validated as a screening tool for sleep apnea in clinical samples, but no occupational studies have reported screening validity parameters for this instrument. The objectives of this pilot study were to describe the prevalence of sleep-disordered breathing symptoms in registered nurses and examine the validity of the Berlin Questionnaire to screen for sleep apnea in this chronically partially sleep-deprived group. Validity parameters for the Berlin Questionnaire are tabulated for published studies to 2012.


Twenty-one female nurses working full time 12-h shifts underwent overnight, in-laboratory polysomnography to identify sleep disorders and completed a Berlin Questionnaire.


By polysomnogram, the prevalence of sleep-disordered breathing [Respiratory Disturbance Index (RDI) ≥ 5] was 43 %, although by the Berlin Questionnaire only 24 % were deemed high risk. The sensitivity of the Berlin Questionnaire to detect high-risk subjects (RDI > 5) was 0.33, with a specificity of 0.83, a positive predictive value of 0.60, and negative predictive value of 0.63. Berlin criterion 3 (obesity or hypertension) performed the best for predicting sleep apnea in 12-h shift nurses.


Although the Berlin Questionnaire produced valuable data about symptoms of sleep apnea in this population, it had a high proportion of false negatives. To improve its sensitivity for screening health care workers for sleep apnea, it must better capture symptoms specific to this population. Increasing the weighting of Berlin criterion 3 items should be considered to improve its psychometric properties.

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