Examining the diagnostic validity of the Berlin Questionnaire in a low-income Black American sample

Study Objectives: Black individuals and individuals of low socioeconomic status are at increased risk for obstructive sleep apnea (OSA). The Berlin Questionnaire is one of the most widely used screening tools for OSA; however, there is limited research on its diagnostic accuracy in low-income Black populations. Methods: This study analyzed data from an ongoing study taking place amonga cohort from 2 predominantly Black neighborhoods in Pittsburgh, Pennsylvania (96.3% Black, 79.6% female). The sample included 269 individuals without a prior diagnosis of OSA who completed the Berlin Questionnaire and also participated in a home sleep apnea test. An apnea-hypopnea index ≥ 15 events/h was used to identify individuals with moderate or severe OSA. Results:19.3%of individualsmetcriteria for moderate to severeOSAbasedonhomesleepapneatest, while31.2%of participants screened as high risk forOSAbased on the overall Berlin index. Using apnea-hypopnea index ≥ 15 events/h as the reference standard, the Berlin Questionnaire had a sensitivity of 46.2%, specificity of 72.4%, positive predictive value of 28.6%,andnegative predictive value of84.9%amongthis sample. Analyses stratifiedbysex suggested that theBerlin Questionnaire had better diagnostic validity in women than men. Conclusions: The Berlin Questionnaire has lower sensitivity and positive predictive value in our sample than those observed in general population samples. The measure performed betteramongwomen, though a higher proportion ofmenfell into the moderate or severeOSArange based on thehomesleep apnea test. Given the significant downstream consequences of OSA, utilizing screening tools that better detect OSA in Black communities is key.